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April 1978

Alcoholic Ketoacidosis and Isopropyl Alcohol Intoxication

Arch Intern Med. 1978;138(4):660. doi:10.1001/archinte.1978.03630280104042

To the Editor.—  The editorial entitled "Cyanide Poisoning—A Challenge" (Archives 137:993-994, 1977) contained a statement that "cyanide intoxication and diabetes mellitus (are) the only two major clinical situations with very high levels of serum acetone and acetone bodies." If indeed cyanide intoxication is a major clinical situation, then I would like to add two additional situations, ie, alcoholic ketoacidosis1 and isopropyl rubbing alcohol intoxication.2The syndrome of alcoholic ketoacidosis occurs in nondiabetic alcoholics, typically after a period of prolonged vomiting and decreased food intake. The fact that a mild ketosis may arise from starvation or prolonged vomiting is well known; the mechanism for the severe ketosis reported in nondiabetic alcoholics remains speculative. The syndrome is probably underdiagnosed because there tends to be an unusually high ratio of β-hydroxybutyrate to acetoacetate; only the latter is measured by the nitroprusside test (Acetest). Therefore, a metabolic acidosis with an apparently unexplained

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