Almaghamsi A M, Yeung C K
Division of Nephrology, University of British Columbia, Vancouver Hospital, Canada.
Clin Nephrol. 1997 Jul;48(1):52-3.
Severe metabolic acidosis in the setting of alcoholism raises diagnostic and therapeutic problems [Levinsky 1994]. Alcoholic ketoacidosis and toxic alcohol ingestion can be difficult to distinguish on initial presentation [Litovitz 1986]. A high osmolal gap associated with increased anion gap acidosis is said to be indicative of toxic alcohol poisoning though this is not at all specific [Salem and Mujais 1992]. Invasive therapeutic manoeuvers as for toxic alcohol poisoning have been recommended empirically before toxicological confirmation when very high osmolarity gaps are reached. Herein, we report two cases of high anion gap metabolic acidosis with very high osmolal gap due to alcoholic ketoacidosis without any evidence of toxic alcohol ingestion.
酒精中毒情况下的严重代谢性酸中毒会引发诊断和治疗方面的问题[莱文斯基，1994年]。酒精性酮症酸中毒和有毒酒精摄入在初次就诊时可能难以区分[利托维茨，1986年]。与阴离子间隙酸中毒增加相关的高渗摩尔间隙据说提示有毒酒精中毒，尽管这一点根本不具有特异性[塞勒姆和穆贾伊斯，1992年]。当达到非常高的渗透压间隙时，在毒理学确认之前，根据经验推荐采取针对有毒酒精中毒的侵入性治疗措施。在此，我们报告两例因酒精性酮症酸中毒导致高阴离子间隙代谢性酸中毒且伴有非常高渗摩尔间隙的病例，未发现任何有毒酒精摄入的证据。
