title: Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis.
abstract: OBJECTIVE
  Diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) are two medical emergencies characterized by elevated total ketone body concentration. We aimed to determine differences in pathogenesis of ketoacidosis and its metabolic consequences by comparing both at presentation and during treatment, the different metabolic products and hormones involved in the ketoacidotic state.
  
  
  METHODS
  We studied 12 patients with DKA and 8 patients with AKA. On admission and every 4 hours for 24 hours during treatment, samples were drawn for determination of serum ketone bodies, lactate and pyruvate, insulin, and counterregulatory hormones (glucagon, cortisol, growth hormone, and catecholamines).
  
  
  RESULTS
  At presentation, with a similar beta-hydroxybutyrate concentration, patients with DKA had a higher plasma glucose (32 mmol/L vs. 6.6 mmol/L), lower beta-hydroxybutyrate/acetoacetate ratio (3:1 vs. 7:1), and a lower lactate/pyruvate ratio (11:1 vs. 19:1) than patients with AKA (all, P < .01). The mean time to resolve ketoacidosis in patients with AKA (6 +/- 1 hour) was significantly shorter than in patients with DKA (16 +/- 2 hours). At presentation, the mean insulin concentration in patients with DKA and AKA were similarly decreased (7.8 +/- 2 and 10.3 +/- 3 microU/mL, P = not significant [NS]). The mean glucagon level before therapy was 203 +/- 15 pg/mL and 188 +/- pg/mL for patients with DKA and AKA, respectively (P = NS). Levels of cortisol, growth hormone, and epinephrine at presentation and during the first 8 hours of treatment were higher in patients with DKA; however, the difference in these values did not reach statistical significance. During therapy, levels of counterregulatory hormones declined at similar rates and returned to normal values after resolution of ketoacidosis.
  
  
  CONCLUSIONS
  Our results indicate that, in addition to a history of diabetes or alcoholism, patients with DKA and AKA differ in their metabolic parameters more than in their hormonal profile. The metabolic profile of DKA is characterized by a higher plasma glucose concentration, and lower beta-hydroxybutyrate to acetoacetate and lactate to pyruvate ratios compared with patients with AKA. The initial hormonal profile in both ketoacidotic states is characterized by similarly decreased insulin levels and elevated levels of counterregulatory hormones.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA 30312, USA.
authors.forename: G E
authors.initials: GE
authors.lastname: Umpierrez
authors.forename: M
authors.initials: M
authors.lastname: DiGirolamo
authors.forename: J A
authors.initials: JA
authors.lastname: Tuvlin
authors.forename: S D
authors.initials: SD
authors.lastname: Isaacs
authors.forename: S M
authors.initials: SM
authors.lastname: Bhoola
authors.forename: J P
authors.initials: JP
authors.lastname: Kokko
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D001786:Blood Glucose / Q000032:analysis; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism* / Q000628:therapy; D003937:Diagnosis, Differential; D004837:Epinephrine / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D007657:Ketone Bodies / Q000097:blood; D007662:Ketosis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism* / Q000628:therapy; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D019289:Pyruvic Acid / Q000097:blood; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin; D007657:Ketone Bodies; D019344:Lactic Acid; D019289:Pyruvic Acid; D013006:Growth Hormone; D005934:Glucagon; D006854:Hydrocortisone; D004837:Epinephrine