title: A patient with clear consciousness even with a glucose level of 5 mg/dL (0.2 mmol/L).
abstract: A 74-year-old man noted dysarthria and right hemiparesis. His history included a gastric ulcer 2 years previously, and he had gradually lost 10 kg over a 2-year period due to appetite loss. He daily consumed 120 mg of alcohol. Upon arrival, he had clear consciousness and stable vital signs. He was malnourished. Neurologic findings included a positive finding of Barre sign in the right hand and dysarthria. A venous blood gas analysis demonstrated the following: pH 7.059; PCO2, 21.5 mm Hg; PO2, 59.1 mm Hg; HCO(3-), 5.8 mmol/L; base excess, -22.7 mmol/L; lactate,17 mmol/L; and glucose, 4 mg/dL. After the administration of an infusion of thiamine and glucose, his abnormal neurologic findings subsided completely. Head magnetic resonance image (MRI; diffusion weighted image) disclosed 3 spotty, high-intensity signals in the brain. The main results of biochemical analyses of the blood collected on arrival were as follows: hemoglobin, 5.5 g/dL; glucose, 5 mg/dL; aspartate aminotransferase, 89 IU/L. He was admitted for further examination and was diagnosed as having alcoholic ketoacidosis with hypoglycemic encephalopathy and anemia due to colon cancer.
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yoshizawa
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Jitsuiki
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Obinata
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Kouhei
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ohsaka
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Oode
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Sugita
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan. Electronic address: yyanaga@juntendo.ac.jp.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yanagawa
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000097:blood / Q000150:complications*; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D003110:Colonic Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003243:Consciousness / Q000502:physiology*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D007662:Ketosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008297:Male
chemical_list: D015415:Biomarkers; D001786:Blood Glucose