Author: Lian Dimaro, Faisal Faruqi / Editor: Steve Corry-Bass / Codes: / Published: 12/11/2020
A 46-year-old man presents with anxiety and feeling overwhelmed. He denies any recent illness and has been drinking alcohol after a prolonged period of abstinence.
He gives a history of anxiety and depression including a previous insulin overdose. He also has a background of chronic pancreatitis, alcohol excess and type 2 diabetes (on insulin).
His observations show tachypnoea (RR24), hypotension (BP 98/64) and tachycardia (HR117). He is otherwise alert, apyrexial and his chest is clear. (Saturations= 97% on air). Abdomen is soft non-tender.
Venous blood gas reveals an elevated anion gap metabolic acidosis – pH 7.27(7.35- 7.45) ), lacticema 2.7mmol/L (0-2), with hypoglycaemia – glucose 2.3mmmol/L (4- 11). Urinary ketones= Nil.
Laboratory bloods show an alcohol level of 134mg/dL. ( Normal <100) , mild neutrophilia, CRP <5, and normal LFTs. He is diagnosed and treated as hypoglycaemia and alcoholic ketoacidosis, with glucose, intravenous fluids and pabrinex. The anxiety resolved as his blood glucose and acidaemia improved.
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Question 1 of 3
1. Question
Alcoholic Ketoacidosis (AKA) is caused by a complex physiology.
Which of the following are common precipitants to AKA? (tick all that apply)