Hôpital Haut-Lévêque, Département d'Endocrinologie, Diabétologie, Nutrition, Pessac, Bordeaux, France.
Hôpital Pellegrin, Département de Biochimie, Bordeaux, France.
Nutrition. 2020 Apr;72:110668. doi: 10.1016/j.nut.2019.110668. Epub 2019 Dec 4.
Ketoacidosis is a severe metabolic complication mainly reported in diabetic patients. Therapeutic fasting is a millennial worldwide practice, believed to improve a large panel of health conditions, but its efficiency and safety profile have not yet been established. We report here a case of euglycemic ketoacidosis in a non-diabetic woman.
A 51-year-old woman without a history of excessive alcohol use or medical history, except for a depressive disorder, was admitted in the emergency room for altered general status, deep asthenia, muscular weakness, articular pain, nausea, vomiting, and consciousness disorders. She was practicing during the previous 48 h a therapeutic fasting following a progressive restrictive diet for 4 d. She was diagnosed with ketoacidosis and hospitalized in the intensive care unit. Her laboratory test results indicated pH 7.28, bicarbonate 7 mmol/L, significant ketone bodies, glycemia 8.9 mmol/L without glycosuria, and negative blood alcohol assessment. Glycated hemoglobin was 5.5%, and blood glucose never went above 9 mmol/L. Serum concentrations of free fatty acids were high at 1.13 mmol/L (normal range: 0.13-0.45). Plasma insulin and peptide C were in the normal ranges. Comprehensive plasma and urinary biochemistry panels, including energetic substrates, and chromatography of amino acids and organic acids did not indicate any energetic or metabolic deficiency. The ketoacidosis regressed, and the overall outcome was favorable after intravenous glucose infusion for 48 h, without insulin requirement.
This report is the first case, to our knowledge, of euglycemic ketoacidosis thought to be induced by therapeutic fasting in a non-diabetic patient. Practitioners should be aware of this complication of fasting.
酮症酸中毒是一种严重的代谢并发症，主要发生在糖尿病患者中。禁食疗法是一种千年历史的全球性实践，被认为可以改善多种健康状况，但它的疗效和安全性尚未得到证实。我们在此报告一例非糖尿病女性的血糖正常性酮症酸中毒病例。
一名 51 岁女性，无过量饮酒史，也无医疗史，除了患有抑郁症外。她因一般状况改变、极度虚弱、肌肉无力、关节疼痛、恶心、呕吐和意识障碍而被收入急诊室。她在过去的 48 小时内进行了禁食治疗，此前她进行了为期 4 天的渐进性限制饮食。她被诊断为酮症酸中毒并住院到重症监护病房。她的实验室检查结果显示 pH 值为 7.28，碳酸氢盐 7 mmol/L，明显的酮体，血糖 8.9 mmol/L 无糖尿，且血液酒精评估为阴性。糖化血红蛋白为 5.5%，血糖从未超过 9 mmol/L。血清游离脂肪酸浓度高，为 1.13 mmol/L（正常范围：0.13-0.45）。血浆胰岛素和 C 肽在正常范围内。全面的血浆和尿液生化谱，包括能量底物，以及氨基酸和有机酸的色谱分析，均未表明存在任何能量或代谢缺陷。酮症酸中毒消退，静脉输注葡萄糖 48 小时后，无需胰岛素治疗，整体预后良好。
据我们所知，这是首例报告的非糖尿病患者因禁食疗法引起的血糖正常性酮症酸中毒病例。从业者应意识到这种禁食相关的并发症。
