Published on Wed Sep 15 2021

Distinguishing between toxic alcohol ingestion vs alcoholic ketoacidosis: how can we tell the difference?

Emily T Cohen, Mark K Su, Rana Biary, Robert S Hoffman

Diagnosing toxic alcohol (TA) ingestion can be challenging. Alcoholic ketoacidosis (AKA) produces an elevated osmol gap and an AGMA. The aim of this study was to identify risk factors suggestive of AKA.

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Abstract

Anion gap metabolic acidosis (AGMA) is common in patients presenting for emergency care. While some disease processes and ingestions are easily excluded, diagnosing toxic alcohol (TA) ingestion can be challenging. This is especially true if drug concentrations are not readily available, which forces clinicians to rely on surrogate markers. Like TA ingestion, alcoholic ketoacidosis (AKA) produces an elevated osmol gap and an AGMA. The aim of this study was to identify risk factors suggestive of AKA when TA ingestion was the primary alternative differential diagnosis. We hypothesized that the odds of an AKA diagnosis would increase as ethanol concentration increased.