Alcoholic Ketoacidosis Sudden Death

Share on facebook

The Challenge Of Sudden Death In Dialysis Patients

Case Presentation A 60-yr-old patient with ESRD (82 kg/168 cm), hypertension for the previous 18 yr, and type 2 diabetes is found dead in bed by his wife at home on a Saturday morning. The patient's history is notable for having started dialysis 34 weeks previously. His last dialysis had been the previous day (on a Friday afternoon). Predialysis potassium had been 5.7 mmol/L, the dialysate K+ was 2.0 mmol/L, and Mg2+ was 0.5 mmol/L. Autopsy was not performed. Before his morbid event, the patient had been doing well on dialysis. He had less than 6 episodes of hypotension (<100 mmHg) per month. His average predialytic weight gain was 4 kg, and, with fluctuations, his average predialysis BP was 155/65 mmHg. While continuing on gliquidone (an oral sulfonylurea hypoglycemic drug that does not accumulate in renal failure), he had no episodes of hypoglycemia, and his last glycosylated hemoglobin level was 7.2%. His medical history is of hypertension, type 2 diabetes, and left ventricular hypertrophy (LVH) with an ejection fraction of 55%. His electrocardiogram showed signs of LVH and flat T waves. He had no history of hypoglycemic episodes and no evidence of retinopathy. He reported no ep Continue reading >>

Share on facebook

Popular Questions

  1. Anonymous

    Hi everyone
    Following some advice on the approaches to managing blood glucose on this forum, I decided to try a very low carbohydrate diet, where my intake didn't go above about 70 to 80 grams per day. I am on Metformin which I take morning and night. It is not the SR version.
    At first, I did feel much better as my blood glucose levels started to come down. Then, something started to happen to me. Following my breakfast of cheese and meats, I go to work or go out to play and at about 10am, I started to slump. In fact I felt quite unwell on a regular basis, and this always happened mid-morning.
    Recently, I travelled to Ashford in Kent for a meeting with my boss and when I arrived at Ashford Station, I just had to sit down. I now recognise what was happening to me - I was hypoglycemic.
    At the kiosk, I bought a small coffee and a sugary snack (a flapjack). Within minutes of eating it, I felt much better and had more energy. In fact, I felt fine. Even my boss noticed, as she noticed I looked pasty when I arrived, but had more colour in my cheeks later on.
    I have tested myself in this state, and get a reading of about 4.5 mmol/l. I wake up with a high BG level, but with the carb-free breakfast and the metformin, this level drops markedly.
    This means that a change of strategy may be called for and I am thinking of two options:
    1. remaining on the same lo carb diet with no metformin in the morning; or,
    2. maintaining the same medication regime, but upping my carbs slightly and, maybe, have a snack if I need to, and having the bulk of the carbs in the morning and easing off by lunchtime.
    I do find that almost completely eliminating carbs from my diet can make for a quite boring eating regime anyway, but I would appreciate some feedback.
    Many thanks

  2. hanadr

    I'd go with the reduced Metformin option, since I always like to minimise medicines. Also add in a LITTLE carb in the morning. Perhaps a piece of fruit?
    I personally eat much less than 70/80grams carb per day and take 2 x 500mg Metformin. I don't seem to make ketones though.

  3. borofergie

    Eating a low-carb diet will not make you hypoglycemic (unless you are also taking more powerful medication than metformin). In fact, the reverse is true, as you start to produce ketones to reduce your brain's glucose requirements your blood glucose levels will stabalise.
    What you describe sounds like a "false hypo", which is a withdrawal symptom, as your body gets used to operating at (more) normal blood glucose levels. You should embrace it, it's a sign that you're starting to get your diabetes under proper control.
    You didn't mention how long you've been on a low-carb diet, but it takes at least a coupe of weeks to adjust first time you try it, during which period you'll also experience the symptoms you've described above, often known as the "low-carb flu".
    I think that sweating it out is a better idea than increasing your carbohydrate intake, but that's your decision. Good luck.

  4. -> Continue reading
read more close

Related Articles

  • Can Diabetes Cause Sudden Death

    Abrupt loss of heart function. Sudden cardiac arrest is often fatal. The victim of sudden cardiac death may or may not have diagnosed heart disease, but the most common cause of sudden cardiac death is coronary heart disease. According to the American Heart Association, sudden cardiac death occurs more than 680 times a day in the United States. The heart has four chambers: two atria at the top and two ventricles at the bottom, which contract to p ...

    diabetes Jan 14, 2018
  • What Is Alcoholic Ketoacidosis?

    Go to: CHARACTERISATION In 1940, Dillon et al1 described a series of nine patients who had episodes of severe ketoacidosis in the absence of diabetes mellitus, all of whom had evidence of prolonged excessive alcohol consumption. It was not until 1970 that Jenkins et al2 described a further three non‐diabetic patients with a history of chronic heavy alcohol misuse and recurrent episodes of ketoacidosis. This group also proposed a possible underl ...

    ketosis Jan 15, 2018
  • Alcoholic Ketoacidosis

    Also found in: Dictionary, Thesaurus, Acronyms, Encyclopedia. alcoholic ketoacidosis the fall in blood pH (acidosis) sometimes seen in alcoholics and associated with a rise in the levels of serum ketone bodies. alcoholic ketoacidosis Acute metabolic ketoacidosis classically seen 1–2 days after an alcohol binge coupled with a decrease in “real” food, resulting in a starvation response, which is exacerbated by vomiting, beta-hydroxybutyrate a ...

    ketosis Jan 4, 2018
  • Alcoholic Ketoacidosis Uptodate

    Acute hyperglycemia, or high blood glucose, may be either the initial presentation of diabetes mellitus or a complication during the course of a known disease. Inadequate insulin replacement (e.g., noncompliance with treatment) or increased insulin demand (e.g., during times of acute illness, surgery, or stress) may lead to acute hyperglycemia. There are two distinct forms: diabetic ketoacidosis (DKA), typically seen in type 1 diabetes, and hyper ...

    ketosis Feb 24, 2018
  • How Does Ketoacidosis Cause Death

    US Pharm. 2016;41(2):39-42. ABSTRACT: Ketoacidosis is a serious medical emergency requiring hospitalization. It is most commonly associated with diabetes and alcoholism, but each type is treated differently. Some treatments for ketoacidosis, such as insulin and potassium, are considered high-alert medications, and others could result in electrolyte imbalances. Several cardiovascular complications are associated with ketoacidosis as a result of el ...

    ketosis Jan 11, 2018
  • Can Ketoacidosis Cause Death

    Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome Severe high blood sugars, ketosis (the presence of ketones prior to acidification of the blood), and ketoacidosis (DKA) are serious and potentially life-threatening medical problems which can occur in diabetes. High blood sugars become life-threatening in Type 1 or long-term Type 2 diabetes only when that person does not receive enough insulin from injections or an insulin pump. This can be cau ...

    ketosis Jan 3, 2018

Popular Articles

More in ketosis

Whoops, looks like something went wrong.