Double gap metabolic acidosis in a Chinese alcoholic

Abstract

Alcoholic ketoacidosis is an important cause of double gap metabolic acidosis. The differential diagnosis includes toxic alcohol (such as methanol and ethylene glycol) ingestion. We report a patient with alcoholic ketoacidosis. He had a history of excessive alcohol intake and presented with repeated vomiting, loss of appetite and hypovolemic shock. Laboratory results revealed high anion gap metabolic acidosis, increased serum osmolal gap, ketonemia, lactic acidosis and acute renal failure. He was successfully treated with hemodialysis, and hydration with glucose and thiamine. 酒精性代謝酮酸中毒是雙重間隙代謝性酸中毒的重要成因，其鑑別診斷為有毒酒精(如甲醇、乙二醇)的攝入。以下個案是一位酒精性代謝酮酸中毒患者，具過度攝入酒精的習慣，入院時呈現重複嘔吐、無食慾、及低血容積性休克。化驗結果顯示高陰離子間隙之代謝性酸中毒、高血清滲透間隙、酮血症、乳酸中毒、及急性腎衰竭。在接受血液透析、合併葡萄糖與硫胺素補充療法後，病人反應良好。