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BMC Endocr Disord 2022 Jun 2;22(1):148. Epub 2022 Jun 2.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Diabetic ketoacidosis (DKA) is a complication of diabetes presenting with high anion gap metabolic acidosis. Methanol poisoning, on the other hand, is a toxicology emergency which presents with the same feature. We present a case of methanol poisoning who presented with DKA. Read More

Cardiovasc Diabetol 2022 05 25;21(1):83. Epub 2022 May 25.

The First Affiliated Hospital, Pharmacy Department, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.

Type 2 diabetes mellitus (T2DM) is a chronic, complex metabolic disease characterized by chronic hyperglycemia causing from insufficient insulin signaling because of insulin resistance or defective insulin secretion, and may induce severe complications and premature death. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are oral drugs used to reduce hyperglycemia in patients with T2DM, including empagliflozin, ertugliflozin, dapagliflozin and canagliflozin. The primary objective of this article is to examine the clinical benefit, safety, and tolerability of the four SGLT2 inhibitors approved by the US FDA. Read More

Cureus 2022 Apr 5;14(4):e23853. Epub 2022 Apr 5.

Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, PRT.

Hepatic glycogenosis (HG) is a rare complication of long-standing poorly controlled type 1 diabetes mellitus (T1DM), which is often misdiagnosed as non-alcoholic fatty liver disease (NAFLD). Despite the existence of several reports in the literature, it still is underrecognized, even among gastroenterologists. Differential diagnosis between these entities is essential since they have different prognoses. Read More

Mol Metab 2022 Jul 12;61:101494. Epub 2022 Apr 12.

University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada. Electronic address:

Objective: Aberrant ketogenesis is correlated with the degree of steatosis in non-alcoholic fatty liver disease (NAFLD) patients, and an inborn error of ketogenesis (mitochondrial HMG-CoA synthase deficiency) is commonly associated with the development of the fatty liver. Here we aimed to determine the impact of Hmgcs2-mediated ketogenesis and its modulations on the development and treatment of fatty liver disease.

Methods: Loss- and gain-of-ketogenic function models, achieved by Hmgcs2 knockout and overexpression, respectively, were utilized to investigate the role of ketogenesis in the hepatic lipid accumulation during postnatal development and in a high-fat diet-induced NAFLD mouse model. Read More

Cureus 2022 Feb 26;14(2):e22633. Epub 2022 Feb 26.

Department of Endocrinology, Mount Sinai Hospital, Chicago, USA.

Diabetes insipidus (DI) is a rare disease characterized by hypotonic urine output and polydipsia. We report the case of a 50-year-old male admitted for diabetic ketoacidosis (DKA) in an intensive care unit with sepsis and alcoholic pancreatitis who later developed DI. He had a high copeptin level of >21. Read More

J Am Coll Emerg Physicians Open 2022 Apr 28;3(2):e12593. Epub 2022 Feb 28.

Banner University Medical Center Phoenix Arizona USA.

Ketoacidosis, a type of high anion gap metabolic acidosis, results from 1 of 3 etiologies: diabetic ketoacidosis, alcoholic ketoacidosis, or starvation ketoacidosis (SKA). In rare instances, young and otherwise healthy lactating women have been found to develop lactation ketoacidosis, a form of SKA, when the high energy requirements of breastfeeding are not met with adequate carbohydrate intake. We present the case of a 29-year-old woman who presented to our emergency department with respiratory distress and headache and was found to have severe lactation ketoacidosis. Read More

Sud Med Ekspert 2022 ;65(1):52-56

Russian Medical Academy of Continuing Professional Education, Moscow, Russia.

The literature review presents data on pathomorphological changes in the kidneys in acute and chronic alcohol intoxication. A lack of consensus among researchers on the direct toxic damage to renal tissue by ethanol is demonstrated. Analysis of the literature showed that the issue of attributing microscopic changes detected in the kidneys to characteristic or specific signs remains controversial. Read More

Biomolecules 2021 12 21;12(1). Epub 2021 Dec 21.

Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, 582 25 Linkoping, Sweden.

Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. Read More

J Med Toxicol 2022 04 18;18(2):155-158. Epub 2022 Jan 18.

Department of Intensive Care, Cliniques St-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium.

Introduction: Severe metabolic acidosis with elevated anion and osmol gap is suggestive of toxic alcohol ingestion. The absence of detectable methanol or ethylene glycol in the serum could mean that metabolism is complete or that other hypotheses have to be considered. Ingestion of less common alcohol or alcoholic ketoacidosis should be investigated as illustrated by the present observation. Read More

J Clin Pathol 2022 Jan 3. Epub 2022 Jan 3.

Department of Medical Education, University of Bristol, Bristol, UK

Aim: To examine the value of vitreous beta-hydroxybutyrate and serum acetone in the investigation of sudden unexpected death.

Methods: Coroners' autopsy reports from a provincial UK city, with a population of approximately 900 000, over a 24-month period with significant ketoacidosis were studied. Demographic features, medical history, anatomical and histological findings, and biochemical parameters, including renal function, vitreous glucose, serum and vitreous alcohol, were analysed. Read More

Indian J Crit Care Med 2021 Oct;25(10):1203-1204

Department of Critical Care, NMC Healthcare, Dubai, United Arab Emirates.

It is important to differentiate between diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) in an alcoholic diabetic patient since it has significant management implications. Ketoacidosis in an alcoholic diabetic patient is a diagnostic challenge as both these clinical entities have metabolic acidosis with high anion gap. Most patients with DKA have hyperglycemia. Read More

J Emerg Med 2021 12 26;61(6):658-665. Epub 2021 Oct 26.

Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois.

Background: Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED) and requires targeted therapies.

Objective: This narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians. Read More

Nutrients 2021 Sep 27;13(10). Epub 2021 Sep 27.

Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea.

Ketone body production, an alternative fuel upon low glucose availability, reduces hepatic fat accumulation. However, its clinical implications have not been established in patients with nonalcoholic fatty liver disease (NAFLD). We investigated the association between spontaneous fasting ketonuria and liver fibrosis in patients with NAFLD without prediabetes and diabetes mellitus (DM). Read More

Am J Emerg Med 2022 02 26;52:270.e5-270.e8. Epub 2021 Aug 26.

Department of Endocrinology, Xi'an Central Hospital, Xi'an, Shaanxi 710003, China. Electronic address:

Alcoholic ketoacidosis (AKA) lacks specific clinical presentation. The results of blood testing commonly show hemoconcentration, elevated β-hydroxybutyrate levels, and acidosis in patients with AKA. Herein, we report a case of AKA accompanied by hyperglycemia and review the related literature. Read More

Med Clin (Barc) 2022 04 29;158(8):393. Epub 2021 Aug 29.

Servicio de Urgencias y coordinación de trasplantes, Hospital de la Santa Creu i Sant Pau, Barcelona, España.

BMJ Case Rep 2021 Aug 19;14(8). Epub 2021 Aug 19.

Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA

Diagnosing uncommon diseases in individuals with underlying medical conditions can be challenging. Cognitive bias can lead to delayed or missed disease management. We present a case of Shiga-toxin mediated hemolytic uremic syndrome (ST-HUS) in a 46-year-old man with ulcerative colitis and alcohol use disorder who presented with acute alcohol intoxication, non-bloody diarrhoea and coffee ground emesis. Read More

Am J Nephrol 2021 19;52(6):467-478. Epub 2021 Jul 19.

Texas Tech Health Sciences Center, El Paso, Texas, USA.

Background: The remarkable ability of the body to adapt to long-term starvation has been critical for survival of primitive man. An appreciation of these processes can provide the clinician better insight into many clinical conditions characterized by ketoacidosis.

Summary: The body adapts to long-term fasting by conserving nitrogen, as the brain increasingly utilizes keto acids, sparing the need for glucose. Read More

Am J Case Rep 2021 Jul 8;22:e932048. Epub 2021 Jul 8.

Department of Emergency Medicine, Marietta Memorial Hospital, Marietta, OH, USA.

BACKGROUND Brugada syndrome is a rare ion channelopathy that can lead to sudden cardiac death and lethal arrhythmias in patients without a structural cardiac defect, the most common of which being the gain-of-function mutation of the SCN5a sodium ion channel involving phase 0 of the cardiac action potential. In 2012, BrS electrocardiogram findings were redefined and classified as either congenital Brugada syndrome (BrS) or Brugada phenocopies (BrP). Several etiologies of BrP have been reported, such as metabolic derangements, electrolyte abnormalities, cardiovascular diseases, and pulmonary embolism. Read More

Forensic Sci Int 2021 Aug 12;325:110878. Epub 2021 Jun 12.

Division of Drug Research, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. Electronic address:

Background: Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions.

Aim: To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations. Read More

Cureus 2021 May 13;13(5):e15015. Epub 2021 May 13.

Internal Medicine, Hamad Medical Corporation, Doha, QAT.

is a Gram-negative bacteria that can infect most of the body's organs, from the lungs to the central nervous system. It is notorious for causing pneumonia in alcoholic, diabetic, and hospitalized patients. It is now emerging as a cause of abscesses involving multiple organs. Read More

Am J Gastroenterol 2021 11;116(11):2270-2278

Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Introduction: Dietary carbohydrate restriction or ketogenic diets are known to be beneficial in preventing liver fat accumulation. However, the effect of ketonemia on the risk of nonalcoholic fatty liver disease (NAFLD) in nondiabetic population is largely unknown. We investigated the association between fasting ketonuria and the risk of incident NAFLD in healthy adults. Read More

Acute Med Surg 2021 Jan-Dec;8(1):e660. Epub 2021 May 11.

Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan.

Background: Methanol poisoning is often suspected in patients with high anion gap metabolic acidosis and visual deficits. Although alcoholic ketoacidosis can cause high anion gap metabolic acidosis, reports on vision loss are limited. We report the case of a patient with alcoholic ketoacidosis with transient total blindness. Read More

Curr Opin Clin Nutr Metab Care 2021 07;24(4):349-353

Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy.

Purpose Of Review: The low fat diet (LFD) is currently the first choice to treat nonalcoholic fatty liver disease (NAFLD) alongside with physical activity. However, low carbohydrate diets (LCDs) and ketogenic diets have gained attention lately, thanks to their favourable impact in reducing intrahepatic triglyceride content. We therefore aimed at providing an update on recent evidence evaluating the hepatoprotective effects of such dietary interventions. Read More

Rev Med Chil 2020 Nov;148(11):1630-1639

Unidad de Endocrinología, Fundación Neuropsiquiátrica de Santiago, Santiago, Chile.

With low carbohydrate diets glucose becomes unavailable as a source of energy for our body, leading to the production of ketones from fatty acids in the liver. The increase in plasma ketones is known as nutritional ketosis. The available evidence from basic and clinical studies indicates that both low carbohydrate and high fat low carbohydrate diets are effective for weight loss and are better than non-intervention. Read More

J Forensic Leg Med 2021 05 31;80:102157. Epub 2021 Mar 31.

Institute of Forensic Medicine, School of Medicine, University of Belgrade, Serbia. Electronic address:

According to the submission guidlines, abstract is not required for this type of article. Read More

Clin Toxicol (Phila) 2021 10 26;59(10):945. Epub 2021 Mar 26.

Ronald O. Perelman Department of Emergency Medicine, Division of Medical Toxicology, NYU Grossman School of Medicine, New York, NY, USA.

Cureus 2021 Feb 19;13(2):e13441. Epub 2021 Feb 19.

Gastroenterology, Bethesda Hospital East, Boynton Beach, USA.

Glycogen hepatopathy (GH), a rare glycogen storage disease caused by genetic or acquired overactivation of hepatic glycogen synthesis enzymes, can mimic non-alcoholic fatty liver disease (NAFLD). We describe a case of biopsy-proven GH in an adult with type 1 diabetes mellitus (DM). A 33-year-old Honduran woman with a 25-year history of type 1 DM complicated by gastroparesis, multiple episodes of diabetic ketoacidosis (DKA) and hypoglycemia, and recurrent pancreatitis was referred for abnormal liver enzymes. Read More

Forensic Sci Int 2021 Apr 15;321:110726. Epub 2021 Feb 15.

Department of Forensic Sciences, Oslo University Hospital, PO Box 4950 Nydalen, Oslo 0424, Norway.

Unexpected death caused by diabetic or alcoholic ketoacidosis is easily overlooked due to the non-specific symptoms. Although the acid betahydroxybutyrate (BHB) is the most abundant ketone body formed in conditions with ketoacidosis, routine analysis in postmortem investigations often only includes the neutral ketone body acetone. This study aims to evaluate the usefulness of implementing routine BHB analysis in postmortem cases, by investigating the relationship between BHB and acetone concentrations in postmortem blood and the main cause of death. Read More

Clin Toxicol (Phila) 2021 10 23;59(10):944-945. Epub 2021 Feb 23.

Division of Nephrology, VHAGLA Healthcare System, Los Angeles, CA, USA.