Characteristics of Severe Alcoholic Ketoacidosis with a Reversible Visual Disturbance

Alcoholic Ketoacidosis (AKA) is an acute metabolic acidosis that typically occurs in people who chronically abuse alcohol and have a recent history of binge drinking, little or no food intake and persistent vomiting [1]. AKA is a result of starvation with glycogen depletion and counter-regulatory hormone production, an increased ratio of Nicotinamide Adenine Dinucleotide (NADH) to Nicotinamide Adenine Dinucleotide (NAD+) related to the metabolism of ethanol, and volume depletion resulting in ketogenesis [1]. This results in a predominant increase of β-hydroxybutyrate and a high anion gap in contrast to the predominant increase of acetoacetate in diabetic ketoacidosis. A urine test strip for the diagnosis of ketonemia is for acetoacetate and acetone but not for β-hydroxybutyrate so that, AKA may be misdiagnosed by using this method. In addition, patients with a severe case of AKA cannot drink alcohol, so the value of alcohol may be zero on arrival. Accordingly, obtaining a history of alcohol consumption and measuring the level of β-hydroxybutyrate is important for patients with metabolic acidosis and a high anion gap to correctly diagnose AKA. The main symptoms of this condition are nausea, vomiting and/ or abdominal pain [2]. These symptoms are usually improved by the infusion of 5% dextrose and thiamine. However, AKA is occasionally associated with multiple complications and treatment in such cases requires a multidisciplinary approach [3].