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Am J Physiol Gastrointest Liver Physiol 2019 Feb 15. Epub 2019 Feb 15.

School of Animal and Comparative Biomedical Scieces, U. Arizona, United States.

Ketosis is a metabolic adaptation to fasting, non-alcoholic fatty liver disease (NAFLD), and prolonged exercise. β-OH butyrate acts as a transcriptional regulator and at G-protein coupled receptors to modulate cellular signaling pathways in a hormone-like manner. While physiological ketosis is often adaptive, chronic hyperketonemia may contribute to the metabolic dysfunction of NAFLD. Read More

Eur J Case Rep Intern Med 2018 27;5(12):000969. Epub 2018 Dec 27.

Department of Internal Medicine, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.

Mauriac syndrome, first described in 1930, is typically diagnosed in young patients with poorly controlled type 1 diabetes mellitus and growth retardation, delayed puberty, Cushingoid features, hypercholesterolaemia and hepatomegaly. However, the sole presenting feature of Mauriac syndrome can be hepatic glycogenosis in both adults and children. The mainstay of treatment for hepatic glycogenosis is strict control of glucose levels, with an excellent prognosis with improved glycaemic control. Read More

Ren Fail 2018 Nov;40(1):693-699

b Department of Internal Medicine , Changwon Gyeongsang National University Hospital , Changwon , South Korea.

Alcoholic ketoacidosis (AKA) is occasionally associated with multiple complications leading to death. However, no study has yet evaluated prognostic factors in patients with AKA. It is known that the logistic organ dysfunction system (LODS) score is an objective and useful index to predict the prognosis. Read More

J Med Case Rep 2018 Dec 14;12(1):368. Epub 2018 Dec 14.

Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Introduction: Acquired partial lipoatrophy has been reported after bone marrow transplantation during childhood; however, no adult cases have previously been reported. We herein report two adult cases of acquired partial lipoatrophy after transplantation.

Case Presentation: A 28-year-old Japanese woman developed diabetic ketoacidosis and received insulin therapy after bone marrow transplantation. Read More

Biochem Pharmacol 2019 Feb 7;160:46-61. Epub 2018 Dec 7.

Center for Pharmacy and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA; Vascular Biology Center, Department of Pharmacology and Toxicology, Augusta University, Augusta, GA, USA; Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA. Electronic address:

Alcoholic ketoacidosis and diabetic ketoacidosis are life-threatening complications that share the characteristic features of high anion gap metabolic acidosis. Ketoacidosis is attributed in part to the massive release of ketone bodies (e.g. Read More

Curr Nutr Rep 2018 09;7(3):97-106

Division of Gastroenterology, University of California Davis, Davis, CA, USA.

Purpose Of Review: The goal of this paper is to review current literature on nutritional ketosis within the context of weight management and metabolic syndrome, namely, insulin resistance, lipid profile, cardiovascular disease risk, and development of non-alcoholic fatty liver disease. We provide background on the mechanism of ketogenesis and describe nutritional ketosis.

Recent Findings: Nutritional ketosis has been found to improve metabolic and inflammatory markers, including lipids, HbA1c, high-sensitivity CRP, fasting insulin and glucose levels, and aid in weight management. Read More

J Forensic Leg Med 2018 Oct 25;59:16-19. Epub 2018 Jul 25.

Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland; Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.

We report a fetal loss following maternal ketoacidosis in a case of cryptic pregnancy. Biochemical analysis of peripheral blood revealed highly elevated levels of beta-hydroxybutyrate (BHB) in the mother (9.2 mmol/l) and the fetus (4. Read More

J Diabetes Investig 2019 Jan 30;10(1):67-72. Epub 2018 Jun 30.

Department of Hepatology and Gastroenterology, Aarhus University, Aarhus C, Denmark.

Introduction: Diabetic ketoacidosis (DKA) is associated with inflammation and increased lipolysis. The macrophage activation marker, soluble CD163 (sCD163), is associated with obesity, non-alcoholic fatty liver disease and type 2 diabetes. We aimed to investigate whether sCD163 correlates with key elements of lipolysis in type 1 diabetes patients during mild DKA. Read More

Chem Biol Interact 2018 Jun 5;289:129-140. Epub 2018 May 5.

Biological Sciences, Clemson University, Clemson, SC 29634, United States; Environmental Toxicology Program, Clemson University, Clemson, SC 29634, United States. Electronic address:

Recent studies indicate a role for the constitutive androstane receptor (CAR), pregnane X-receptor (PXR), and hepatic xenobiotic detoxifying CYPs in fatty liver disease or obesity. Therefore, we examined whether Cyp3a-null mice show increased obesity and fatty liver disease following 8-weeks of exposure to a 60% high-fat diet (HFD). Surprisingly, HFD-fed Cyp3a-null females fed a HFD gained 50% less weight than wild-type (WT; B6) females fed a HFD. Read More

PLoS One 2018 19;13(4):e0195920. Epub 2018 Apr 19.

PACEA-UMR 5199, University of Bordeaux, Pessac, France.

The exhumation of Danish astronomer Tycho Brahe (1546-1601) was performed in 2010 to verify speculative views on the cause of his death. Previous analyses of skeletal and hair remains recovered from his grave refuted the presumption that he died from poisoning. These studies also outlined the possibility that he actually died from an acute illness, echoing the rather vague and inaccurate testimony of some historical records. Read More

Diabetes Metab 2018 11 21;44(5):437-443. Epub 2018 Mar 21.

Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai key Laboratory of Diabetes Mellitus, 600, Yishan Road, 200233 Shanghai, China. Electronic address:

Aim: As the prevalence and clinical characteristics of non-alcoholic fatty liver disease (NAFLD) are still unknown in ketosis-onset diabetes, the present study compared the characteristics of NAFLD in type 1 diabetes (T1D), ketosis-onset and non-ketotic type 2 diabetes (T2D) patients.

Methods: This cross-sectional study was performed with newly diagnosed Chinese patients with diabetes, including 39 T1D, 165 ketosis-onset and 173 non-ketotic T2D, with 30 non-diabetics included as controls. NAFLD was determined by hepatic ultrasonography, then its clinical features were analyzed and its associated risk factors evaluated. Read More

World J Hepatol 2018 Feb;10(2):172-185

Department of Gastroenterology and Hepatology, NYP-Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States.

Glycogenic hepatopathy (GH) is a rare complication of the poorly controlled diabetes mellitus characterized by the transient liver dysfunction with elevated liver enzymes and associated hepatomegaly caused by the reversible accumulation of excess glycogen in the hepatocytes. It is predominantly seen in patients with longstanding type 1 diabetes mellitus and rarely reported in association with type 2 diabetes mellitus. Although it was first observed in the pediatric population, since then, it has been reported in adolescents and adults with or without ketoacidosis. Read More

Lakartidningen 2017 10 3;114. Epub 2017 Oct 3.

- , Sweden - , Sweden.

Alcoholic ketoacidosis - a review A chronic alcoholic with severe metabolic acidosis presents a difficult diagnostic problem in the emergency room. Over and above methanol- and ethylene glycol intoxication, alcoholic ketoacidosis is a common but less recognized etiology. The disorder occurs in alcoholics who have had a recent binge drinking followed by the abrupt cessation of alcohol consumption because of abdominal pain and vomiting, with resulting dehydration, starvation, and then a β-hydroxybutyrate dominated ketoacidosis. Read More

Forensic Sci Med Pathol 2017 Sep 1;13(3):278-283. Epub 2017 Jul 1.

CRY Department of Cardiovascular Pathology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.

There is growing awareness of sudden unexplained death in alcohol misuse (SUDAM) in which there is no obvious cause of death, no evidence of acute alcohol toxicity or alcoholic ketoacidosis, and the heart is morphologically normal. This study describes the characteristics of a cohort with SUDAM from a tertiary cardiovascular referral center and compares the findings with those of individuals who died from sudden arrhythmic death syndrome (SADS). Cases in this retrospective cross-sectional study were identified from a database of referrals to our center spanning approximately 40 years. Read More

J Endocrinol 2017 Jul 20;234(1):R1-R21. Epub 2017 Apr 20.

School of Animal and Comparative Biomedical SciencesUniversity of Arizona, Tucson, Arizona, USA

Fatty liver can be diet, endocrine, drug, virus or genetically induced. Independent of cause, hepatic lipid accumulation promotes systemic metabolic dysfunction. By acting as peroxisome proliferator-activated receptor (PPAR) ligands, hepatic non-esterified fatty acids upregulate expression of gluconeogenic, beta-oxidative, lipogenic and ketogenic genes, promoting hyperglycemia, hyperlipidemia and ketosis. Read More

J Gen Intern Med 2017 Jun 21;32(6):714-717. Epub 2017 Feb 21.

Department of Pathology, Loyola University Stritch School of Medicine, Room 7612, 2160 S 1st Avenue, Maywood, IL, 60153, USA.

Glycogenic hepatopathy (GH) is an underdiagnosed complication of uncontrolled type 1 diabetes mellitus (T1DM). It appears as an acute relapsing hepatitis with reversible transaminase elevations secondary to excessive hepatic glycogen accumulation. Patients are often asymptomatic but can present with abdominal pain, nausea and vomiting. Read More

Scand J Clin Lab Invest 2017 Apr 2;77(2):149-152. Epub 2017 Feb 2.

a Department of Pharmacology , Oslo University Hospital , Oslo , Norway.

A rapid gas chromatographic mass spectrometric method for measuring anions associated with acute anion gap metabolic acidosis is described. The method is an extension of a previous method. The method quantifies glycolic acid, beta-hydroxybutyric acid with good linearity and pyroglutamic acid with a reproducible curvature relation between 1 and 20 mmol/L and can help the clinician distinguish effectively between ethylene glycol poisoning, alcoholic and diabetic ketoacidosis and cysteine deficiency so early that it will have clinical consequences. Read More

J Forensic Sci 2017 May 30;62(3):681-685. Epub 2017 Jan 30.

School of Medicine, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.

Basal vacuolization of renal tubular epithelial cells is a useful postmortem marker for ketoacidosis. To investigate its incidence and relationship to the severity of ketoacidosis, 158 autopsy cases with elevated β-hydroxybutyrate (>1 mmol/L) over a 7-year-period were retrospectively reviewed. Sixty-eight cases (43%) exhibited basal vacuolizations (vitreous β-hydroxybutyrate: 1. Read More

J Forensic Sci 2017 Mar 16;62(2):519-524. Epub 2016 Nov 16.

Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 165 Ashley Avenue, Charleston, SC, 29425.

Diabetes mellitus (DM) is a common disease involving insulin resistance or deficit that, when left unchecked, may cause severe hyperglycemia and subsequent end-organ damage. Acute pancreatitis (AP) is inflammation of the pancreas that can lead to significant morbidity and mortality. AP and DM both account for a significant amount of sudden deaths, and rarely both disease processes may be present in the same decedent, causing some difficulty in wording the cause of death statement. Read More

J Clin Med Res 2016 Dec 26;8(12):919-920. Epub 2016 Oct 26.

Department of Medicine, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, QC, H2W 1T8, Canada.

Although much more rare than its diabetic counterpart, ketoacidosis secondary to alcohol withdrawal in the context of fasting has its own complex pathophysiology and can easily mimic the acute insulin deficiency presentation. We present here a rare case of a non-diabetic alcoholic patient who presented in ketoacidosis after a period of reduced intake. Read More

J Emerg Med 2016 Oct;51(4):447-449

Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

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.

Case Report: 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. Read More

Nihon Arukoru Yakubutsu Igakkai Zasshi 2016 Oct;51(5):283-292

Forensic pathologists.frequently encounter sudden natural.death of alcoholic in which fatty liver is the only pathological finding detected at autopsy, however, characteristics of postmortem CT (PMCT) of sudden death of alcoholic have not been reported so far. Read More

Arch Kriminol 2016 Aug;238(1-2):57-63

In a study on alcoholics, diabetics, cases of hypothermia, combinations of alcoholism, diabetes and hypothermia as well as 55 controls, ketone body measurements were performed in femoral vein blood, heart blood, vitreous humor, cerebrospinal fluid and urine. Histological investigations were carried out on the kidneys of the deceased. In addition to HE-staining, the cuts were stained with Sudan and PAS to allow differentiation between lipids and glycogens. Read More

Nihon Arukoru Yakubutsu Igakkai Zasshi 2016 Jun;51(3):234-240

A 48-year-old Japanese woman with >10 years history of alcoholic had been falling repeatedly during 1 week before her death. She complained of nausea and did not eat or drink for 2 days. Thereafter, she became drowsy and she was transferred to the hospital. Read More

J Forensic Leg Med 2016 Aug 4;42:51-5. Epub 2016 May 4.

Laboratory of Clinical Chemistry, Lausanne University Hospital, Lausanne, Switzerland.

Significantly increased blood ketone body levels can be occasionally observed in the forensic setting in situations other than exposure to cold, diabetic or alcoholic ketoacidosis. Though infrequent, these cases do occur and deserve thorough evaluation in order to establish appropriate differential diagnoses and quantify the role that hyperketonemia may play in the death process. Starvation ketoacidosis is a rare cause of metabolic acidosis and is a phenomenon that occurs normally during fasting, as the body switches from carbohydrate to lipid energy sources. Read More

J Forensic Leg Med 2016 Jul 19;41:49-57. Epub 2016 Apr 19.

Toxicology Unit, Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK; Toxicology Unit, Dept of Pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.

The results of biochemical analyses in specimens obtained postmortem may aid death investigation when diabetic and alcoholic ketoacidosis is suspected, when death may have been the result of drowning, anaphylaxis, or involved a prolonged stress response such as hypothermia, and in the diagnosis of disease processes such as inflammation, early myocardial infarction, or sepsis. There is often cross-over with different disciplines, in particular with clinical and forensic toxicology, since some endogenous substances such as sodium chloride, potassium chloride, and insulin can be used as poisons. The interpretation of results is often complicated because of the likelihood of postmortem change in analyte concentration or activity, and proper interpretation must take into account all the available evidence. Read More

Crit Care Med 2016 Aug;44(8):1545-52

1Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY. 2Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY. 3Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky College of Medicine, Lexington, KY.

Objective: Patients with a chronic alcohol use disorder presenting to the ICU may be deficient in important vitamins and electrolytes and are often prescribed a "banana bag" as a reflexive standard of therapy. The difficulty of diagnosing Wernicke's encephalopathy in the critical care setting is reviewed. Furthermore, whether the contents and doses of micronutrients and electrolytes in standard banana bags meet the needs of critically ill patients with an alcohol use disorder is assessed based on available evidence. Read More

Oxf Med Case Reports 2016 Mar 3;2016(3):31-3. Epub 2016 Mar 3.

Department of Gastroenterology , West Suffolk Hospital , Bury St Edmunds , UK.

Alcoholic ketoacidosis (AKA) is a cause of severe metabolic acidosis usually occurring in malnourished patients with a history of recent alcoholic binge, often on a background of alcohol dependency. AKA can be fatal due to associated electrolyte abnormalities and subsequent development of cardiac arrhythmias. This is a diagnosis that is often delayed or missed, in patients who present with a severe lactic and ketoacidosis. Read More

Perm J Spring 2016;20(2):71-3. Epub 2016 Feb 22.

Consultant in Medicine at the Dunedin Hospital; and an Honorary Clinical Senior Lecturer at the University of Otago School of Medicine in Dunedin, New Zealand; Clinical Assistant Professor of Medicine at Stanford University School of Medicine; and a Hospitalist at the Santa Clara Medical Center in CA.

A 31-year-old woman presented to the hospital with symptoms of nausea, malaise, and emesis. She was breastfeeding her 10-month-old infant. She was found to have severe ketoacidosis. Read More

Fa Yi Xue Za Zhi 2015 Aug;31(4):287-92, 297

Postmortem chemistry is becoming more and more essential in routine forensic pathology and has made considerable progress over the past years. Biochemical analyses of vitreous humor, blood, urine and cerebrospinal fluid may provide important information in determining the cause of death or in elucidating forensic issues. Postmortem chemistry may be essential for the determination of cause of death when morphological methods (diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders) cannot detect the pathophysiological changes involved in the death process. Read More

Arch Kriminol 2015 Sep-Oct;236(3-4):103-14

Alcoholic ketoacidosis is a medical emergency, which is characterized at first by an elevated level of ketone bodies. The production of these ketone bodies is accompanied by an equimolar quantity of hydrogen ions and thus causes acidosis, which cannot be detected post-mortem due to anaerobic glycolysis, whereas the three ketone bodies beta-hydroxybutyrate, acetoacetate and acetone can be easily identified. However, the limits of ketone body concentrations mentioned in the literature for diagnosing ketoacidosis vary significantly, partly due to inhomogeneous study groups. Read More

Alcohol Alcohol 2016 May 4;51(3):268-74. Epub 2015 Nov 4.

National Hospital Organization Kurihama Medical and Addiction Center, Kanagawa 239-0841, Japan.

Aims: To identify determinants of hyperuricemia in alcoholics.

Methods: The serum uric acid (UA) levels of 1759 Japanese alcoholic men (≥40 years) were measured on their first visit or within 3 days after admission; ADH1B and ALDH2 genotyping on blood DNA samples were performed. Dipstick urinalyses for ketonuria and serum UA measurements were simultaneously performed for 621 men on their first visit. Read More

Am J Emerg Med 2016 May 23;34(5):941.e3-4. Epub 2015 Oct 23.

Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan; Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Izunokuni city, Shizuoka, Japan. Electronic address:

A 74-year-old man noted dysarthria and right hemiparesis. His history included a gastric ulcer 2 years previously, and he had gradually lost 10 kg over a 2-year period due to appetite loss. He daily consumed 120 mg of alcohol. Read More

Minerva Endocrinol 2016 Mar 16;41(1):70-7. Epub 2015 Oct 16.

Section of Endocrinology, Diabetes and Nutrition, Department of Medicine Boston University School of Medicine and Boston Medical Center, Boston, MA, USA -

The aim of this paper is to review the relevant literature related to the epidemiology, pathophysiology, natural history, clinical features and treatment of fibrocalculous pancreatic diabetes (FCPD). We review the English-language literature on this topic published between 1956 and 2014. FCPD is a form of diabetes usually associated with chronic calcific pancreatitis. Read More

PLoS One 2015 20;10(8):e0136078. Epub 2015 Aug 20.

Institute of Animal Nutrition, Federal Research Institute for Animal Health, Friedrich-Loeffler-Institute, Braunschweig, Germany.

The inhibition of dipeptidyl peptidase-4 (DPP4) via specific inhibitors is known to result in improved glucose tolerance and insulin sensitivity and decreased accumulation of hepatic fat in type II diabetic human patients. The metabolic situation of dairy cows can easily be compared to the status of human diabetes and non-alcoholic fatty liver. For both, insulin sensitivity is reduced, while hepatic fat accumulation increases, characterized by high levels of non-esterified fatty acids (NEFA) and ketone bodies. Read More

J UOEH 2015 Mar;37(1):43-7

Department of neurology, JCHO (Japan Community Health care Organization) Kyushu Hospital.

We report a 55 year old Japanese man with a history of alcohol abuse, who was in a near fasting state for the previous few days.He was admitted to our hospital with abrupt disturbance of consciousness. He presented disturbance of consciousness with extreme hypoglycemia and ketoacidosis with high β-hydroxybutyric acid concentration. Read More

Am J Physiol Endocrinol Metab 2015 May 24;308(9):E744-55. Epub 2015 Feb 24.

Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Policlinico Tor Vergata Foundation, Rome, Italy;

Liver has a principal role in glucose regulation and lipids homeostasis. It is under a complex control by substrates such as hormones, nutrients, and neuronal impulses. Insulin promotes glycogen synthesis, lipogenesis, and lipoprotein synthesis and inhibits gluconeogenesis, glycogenolysis, and VLDL secretion by modifying the expression and enzymatic activity of specific molecules. Read More

J Pediatr Endocrinol Metab 2015 Mar;28(3-4):333-5

Real euglycemic diabetic ketoacidosis [DKA; blood glucose <200 mg/dL (11.1 mmol/L)] is rare, and long-lasting starvation conditions due to intervening diseases in type 1 diabetes mellitus patients may also cause it. Euglycemic DKA is also reported in insulin-dependent diabetics with depression, alcoholics, glycogen storage diseases, and chronic liver disease apart from pregnant cases. Read More

Soud Lek Fall 2014;59(4):48-50

Unlabelled: Alcohol accounts for a great amount of deaths per year either due to the acute intoxication or due to the secondary impacts of acute or chronic alcoholism. Commonly, in large amount of such fatal cases blood alcohol concentration is low or absent and fatty liver disease is frequently the only pathological finding detected at the autopsy of alcohol consumer. We offer a short case report of a case with the following analysis of why we decided to consider alcoholic ketoacidosis in our differential diagnosis. Read More

Alcohol Alcohol 2014 Nov 22;49(6):687-8. Epub 2014 Sep 22.

University Centre of Legal Medicine, rue du Bugnon 21, 1011 Lausanne, Switzerland.

Alcohol Alcohol 2014 Nov 21;49(6):687. Epub 2014 Sep 21.

Institute of Forensic Medicine, University of Southern Denmark, Winsløwparken 17B, DK-5000 Odense C, Denmark

Alcohol Alcohol 2014 Nov 1;49(6):618-25. Epub 2014 Aug 1.

National Hospital Organization Kurihama Medical and Addiction Center, Kanagawa 239-0841, Japan.

Aims: Alcoholic ketosis and ketoacidosis are metabolic abnormalities often diagnosed in alcoholics in emergency departments. We attempted to identify determinants or factors associated with alcoholic ketosis.

Methods: The subjects of this cross-sectional survey were 1588 Japanese alcoholic men (≥40 years) who came to an addiction center within 14 days of their last drink. Read More

J Diabetes Res 2014 13;2014:510643. Epub 2014 Apr 13.

Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China.

Diabetic ketosis had been identified as a characteristic of type 1 diabetes mellitus (T1DM), but now emerging evidence has identified that they were diagnosed as T2DM after long time follow up. This case control study was aimed at comparing the clinical characteristic, β-cell function, and insulin resistance of ketosis and nonketotic onset T2DM and providing evidence for treatment selection. 140 cases of newly diagnosed T2DM patients were divided into ketosis (62 cases) and nonketotic onset group (78 cases). Read More

Emerg Med Clin North Am 2014 May 19;32(2):293-301. Epub 2014 Feb 19.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Baltimore, MD 21201, USA. Electronic address:

Ethanol intoxication and ethanol use are associated with a variety of metabolic derangements encountered in the Emergency Department. In this article, the authors discuss alcohol intoxication and its treatment, dispel the myth that alcohol intoxication is associated with hypoglycemia, comment on electrolyte derangements and their management, review alcoholic ketoacidosis, and end with a section on alcoholic encephalopathy. Read More

Basic Clin Pharmacol Toxicol 2014 Nov 28;115(5):472-5. Epub 2014 Apr 28.

Department of Pharmacy & Pharmacology, Slotervaart Hospital, Amsterdam, The Netherlands.

An intoxication with drugs, ethanol or cleaning solvents may cause a complex clinical scenario if multiple agents have been ingested simultaneously. The situation can become even more complex in patients with (multiple) co-morbidities. A 59-year-old man with type 2 diabetes mellitus (without treatment two weeks before the intoxication) intentionally ingested a substantial amount of ethanol along with ~750 mL of laminate floor cleaner containing citric acid. Read More

BMJ Case Rep 2014 Feb 25;2014. Epub 2014 Feb 25.

Acute Medicine, Endocrinology & Diabetes, Stepping Hill Hospital, Stockport, UK.

Chronic alcoholism is a frequently unrecognised cause of ketoacidosis. Most patients with alcoholic ketoacidosis present with normal or low glucose, but this condition can present with hyperglycaemia. This can lead to misdiagnosis of diabetes ketoacidosis and, therefore, inappropriate treatment with insulin. Read More

Alcohol Alcohol 2014 May-Jun;49(3):271-81. Epub 2013 Dec 10.

Corresponding author: University Center of Legal Medicine, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

Aims: The aim of this article is to review the forensic literature covering the postmortem investigations that are associated with alcoholic ketoacidosis fatalities and report the results of our own analyses.

Methods: Eight cases of suspected alcoholic ketoacidosis that had undergone medico-legal investigations in our facility from 2011 to 2013 were retrospectively selected. A series of laboratory parameters were measured in whole femoral blood, postmortem serum from femoral blood, urine and vitreous humor in order to obtain a more general overview on the biochemical and metabolic changes that occur during alcoholic ketoacidosis. Read More

Acute Med Surg 2014 Apr 16;1(2):109-114. Epub 2013 Dec 16.

Department of Emergency Medicine Matsusaka Chuo Hospital Matsusaka Mie Japan.

Case: Alcoholic ketoacidosis (AKA) usually occurs in patients with a history of prolonged alcohol abuse and recent binge drinking followed by abrupt cessation of alcohol consumption.

Outcome: A 61-year-old man was brought to our emergency department. He had a history of eating barbecued beef with beer the previous night. Read More