Diabetic ketoacidosis and pregnancy related ketoacidosis are the most common forms of ketoacidosis seen in acute medical units. We describe here two rare cases of starvation ketoacidosis.
Case 1: 63 years old gentleman with no history of diabetes, presented with persistent vomiting for 48 hours. His admission bloods revealed Serum Bicarbonate of 8, pH 7.19, pCO2 2.7, base excess of -17.8, plasma glucose 5.2 mmol/l and serum alcohol <100. Serum ketones were 3.4 mmol/l. He was managed with iv fluids mainly with dextrose infusions. His symptoms, serum ketones and pH levels normalised while his blood glucose remained stable over 3 days and was discharged home.
Case 2: 67 years lady with past history of COPD, excess alcohol intake and osteoporosis, presented with feeling unwell, since she stopped eating after she had an argument with her son 5 days ago. Her bloods revealed Serum Bicarbonate of 14, pH 7.43, pCO2 3.5, base excess of -4.7, plasma glucose 6.7 mmol/l and serum alcohol <100. Serum ketones were 3.4 mmol/l. She was managed with iv fluids mainly with dextrose infusions with iv Vitamin B complex. Her symptoms, serum ketones and pH levels normalised while her blood glucose remained stable over next day and was discharged home.
These two cases highlight the condition of starvation ketoacidosis, being a significant cause of metabolic acidosis, presented with symptoms of vomiting and being unwell respectively. Prompt diagnosis and treatment targeted to correct volume and calorie (mainly from carbohydrates) deficit helped to move these patients from a metabolic state based on fatty acid catabolism to eumetabolic state. Distinction from diabetic keto-acidosis is extremely important. If misdiagnosed as euglycaemic diabetic ketoacidosis, consequent inappropriate insulin therapy would lead to hypoglycaemia in an already carbohydrate depleted individual.