Alcoholic Ketoacidosis

Three alcoholic women (ages 27 to 44) were studied during episodes of severe ketoacidosis and dehydration. In two, these incidents were recurrent. Just before admission, an increase in alcohol consumption was followed by anorexia, vomiting, dehydration, and hyperpnea. On admission, blood glucose level was normal or moderately elevated, glycosuria was absent or trivial, and alcohol had disappeared from blood, but ketoacidosis was sometimes severe. Although blood transfusion was sometimes necessary to combat hypotension, patients usually improved when given only glucose and saline solution without insulin. Slightly impaired glucose tolerance was present soon after admission. Direct damage to hepatic mitochondria by alcohol, persisting long after alcohol is gone, appears to be the best explanation of the underlying defect, although some additional factor peculiar to the patient appears to be necessary to explain the rarity of the syndrome.