Alcoholic Ketoacidosis Differential Diagnoses

  • Author: George Ansstas, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: May 19, 2011
 
 

Diagnostic Considerations

It can be difficult at presentation to distinguish between ethanol, methanol, and ethylene glycol toxicity in an alcoholic patient with a high–anion gap metabolic acidosis and an osmolal gap. Additional possibilities, which may be concurrent abnormalities, include lactic acidosis and diabetic ketoacidosis. Thus, the diagnostic evaluation should include a careful history, an assessment for ketonemia or ketonuria, a urinalysis (eg, an evaluation for calcium oxalate crystals), and a measurement of serum levels of suspected toxins.

Isopropyl alcohol ingestion differs from AKA because it leads to ketosis without acidosis. This occurs because isopropyl alcohol is metabolized to acetone (a ketone but not a carboxylic acid, unlike acetoacetate).

The AKA differential diagnosis includes all metabolic conditions that can cause an increased–anion gap metabolic acidosis in a person who abuses ethanol. Salicylate intoxication and metabolic alkalosis must be considered. If the plasma glucose level is elevated above 300 mg/dL upon presentation, consider diabetic ketoacidosis.[14, 15, 16, 17]

Because AKA is often precipitated by another medical illness, the diagnostic evaluation should include a search for potential precipitating factors when not clearly identified by history. Other disorders that may be seen in patients with AKA include the following:

Differential Diagnoses

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Contributor Information and Disclosures
Author

George Ansstas, MD  Chief Resident, Department of Internal Medicine, St Louis University Hospital; Assistant Professor, Department of Internal Medicine, St Louis University School of Medicine

George Ansstas, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Irina Robinson  MD, Fellow, Department of Endocrinology and Metabolism, University of New Mexico School of Medicine and Health Sciences Center

Irina Robinson is a member of the following medical societies: American Association of Clinical Endocrinologists and American College of Physicians

Disclosure: Nothing to disclose.

Sofya M Rubinchik, MD  Consulting Staff, Department of Behavioral Health, Lovelace Medical Center

Sofya M Rubinchik, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Neuropsychiatric Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

David S Schade, MD  Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center

David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS  Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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