The fatal booze!—triple acid-base disorder in a patient with alcohol intoxication

Abstract

Patients of chronic alcohol abuse can present with a variety of acid-base disorders and electrolyte disturbances. Lactic acidosis (LA) along with alcoholic ketoacidosis is an infrequent and underappreciated cause of wide anion-gap metabolic acidosis in alcoholic patients. The likelihood of misdiagnosing the condition is high because of the lack of awareness and presence of nonspecific clinical signs and symptoms shared with other clinical abnormalities such as acute pancreatitis, methanol or ethylene glycol poisoning, and diabetic ketoacidosis, which exist in these patients. As this condition is reversible with early intervention, promptly recognizing the condition and initiating proper treatment by the physicians would go a long way in preventing the morbidity and mortality in these patients. The outcome for such patients is excellent with early intervention. We report a patient with history of chronic alcoholism and alcohol binge admitted to the emergency department with triple acid-base disorder, which included life-threatening high anion-gap metabolic acidosis owing to concomitant LA and alcohol-related ketoacidosis in which the primary element was LA along with metabolic and respiratory alkalosis.