Bernuau J, Nouel O, Degos F, Rueff B, Benhamou J P
Nouv Presse Med. 1979 Nov 12;8(44):3625-7.
Chronic alcoholism is a frequently unrecognized cause of ketoacidosis in nondiabetic patients. Seven episodes of alcoholic ketoacidosis were observed in three patients. No consciousness disturbances were present. Semi-quantitative tests for ketones were strongly positive in urine, weakly positive in serum. The anion gap was between 25 and 41 mEq/l; serum lactate was between 0.9 and 9.0 mEq/l, and, in all cases, below the anion excess. Blood glucose ammonia was increased. Massive fatty liver was documented in all patients. All ketosis episodes followed an increase of alcohol ingestion associated with one to four week-starvation and vomiting; however, at the time of admission, alcohol was weakly increased in blood. In the four episodes where diagnosis was correct, ketoacidosis was rapidly corrected without insulin administration. In conclusion, in some nondiabetic subjects, the occurence of alcohol prolongated ingestion together with starvation and vomiting is responsible for ketoacidosis; because alcoholic ketoacidosis has often a mild clinical expression, its true prevalence is underestimated; insulin administration is not required.
慢性酒精中毒是非糖尿病患者酮症酸中毒的一个常被忽视的病因。在三名患者中观察到七次酒精性酮症酸中毒发作。患者均无意识障碍。酮体的半定量检测在尿液中呈强阳性，在血清中呈弱阳性。阴离子间隙在25至41 mEq/l之间；血清乳酸在0.9至9.0 mEq/l之间，且在所有病例中均低于阴离子过剩值。血糖氨升高。所有患者均记录有重度脂肪肝。所有酮症发作均发生在酒精摄入量增加且伴有1至4周饥饿和呕吐之后；然而，入院时血液中的酒精含量略有升高。在诊断正确的四次发作中，未使用胰岛素，酮症酸中毒迅速得到纠正。总之，在一些非糖尿病患者中，长时间饮酒伴饥饿和呕吐会导致酮症酸中毒；由于酒精性酮症酸中毒的临床表现通常较轻，其实际患病率被低估；无需使用胰岛素。
