Abstract
A 51-year-old man drank two bottles of whisky and passed out. He woke with epigastric pain, which worsened during the day, and he vomited six times. Although normally teetotal, he binged sporadically. On presentation, he was tachycardic with a normal blood pressure, and inebriated with a Glasgow Coma Scale of 15. Urinalysis revealed a trace of ketones and pH of 5. Arterial blood gas analysis demonstrated severe metabolic acidosis with pH 6.73 (normal range (NR)=7.35–7.45), pO2 19.1 kPa (NR >10.6 kPa), pCO2 2.54 kPa (NR 4.7–6 kPa), bicarbonate 4 mmol/litre (NR 22–28 mmol/litre) and lactate 22 mmol/litre (NR 0.5–1.6 mmol/litre). He was diagnosed with severe alcohol-related lactic acidosis. Fluid resuscitation, broad-spectrum antibiotics and a proton pump inhibitor were commenced. He was given 1 litre of 1.26% sodium bicarbonate. The next morning after 7 litres of crystalloid and 75 ml of 8.4% sodium bicarbonate the patient was much improved with only mild epigastric pain. He had a pH of 7.53, bicarbonate of 27 mmol/litre and lactate of 1.7 mmol/litre. He was monitored for 24 hours and discharged.
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