title: A Patient With Alcoholic Ketoacidosis and Profound Lactemia.
abstract: BACKGROUND
  Alcoholic ketoacidosis (AKA) is a complex syndrome that results from disrupted metabolism in the setting of excessive alcohol use and poor oral intake. Dehydration, glycogen depletion, high redox state, and release of stress hormones are the primary factors producing the characteristic anion gap metabolic acidosis with an elevated β-hydroxybutyrate (β-OH) and lactate.
  
  
  METHODS
  We present the case of a 47-year-old man who presented to the emergency department with metabolic acidosis and profoundly elevated lactate levels who had AKA. He recovered completely with intravenous fluids and parenteral glucose administration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should always consider the immediately life-threatening causes of a severe anion gap metabolic acidosis and treat aggressively based on the situation. This case highlights the fact that AKA can present with an impressively elevated lactate levels. Emergency physicians should keep AKA in the differential diagnosis of patients who present with a similar clinical picture.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Gerrity
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Pizon
authors.affiliation: Children's Hospital of Michigan Regional Poison Control Center, Detroit, Michigan.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: King
authors.affiliation: Lehigh Valley Health Network, Department of Emergency Medicine, Section of Medical Toxicology, Allentown, Pennsylvania.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Katz
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Menke
mesh_terms: D000136:Acid-Base Equilibrium; D000437:Alcoholism / Q000150:complications; D005440:Fluid Therapy; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D065906:Hyperlactatemia / Q000097:blood / Q000628:therapy*; D007662:Ketosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged
chemical_list: D019344:Lactic Acid; D005947:Glucose
keywords: acidosis; alcohol; ketones; lactate