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Old 07-26-2012
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Question cause of this metabolic acidosis

previously healthy 18 year male , comes to the ER with diffuse abdominal pain associated with nausea for the past 6 hours. He has decreased appetite since 24 hours. He is not on any medications. He drinks 3-4 beers per day during the week and has habits of binge drinking on weekends. He doesnt abuse illicit drugs.

On examination his temp is found to be 100F with HR=120/min and RR=24/min, BP= 100/60mmHg.

Abdomen palpation shows diffuse tenderness without any guarding or rigidity. Bowel sounds are normal.

Lab values
Na- 140
K-4.0
Cl -- 98
HCO3 -- 16
Glucose -- 250
Blood ketones -- positive
urinary Ketones -- Positive.

ABG -- shows a pH or 7.30

what is the most likely diagnosis--?
A- DKA
B- Alcoholic Ketoacidosis
C- Lactic Acidosis
D- acute appendicits.
E- Perforation of Abdominal Viscera.
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Old 07-26-2012
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alcoholic ketoacidosis
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  #3  
Old 07-26-2012
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Default B

There's little confusing btw A& B, but would go with B, as the hx & moderate elevation in bl. glucose are more suggestive.
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Old 07-26-2012
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i thought so too.
but the answer is DKA..

now heres my confusion.

1- NORMAL potassium levels ----- goes highly AGAINST DKA.
2- Glucose levels --- NOT markedly elevated.
3- Nothing in the history going in favor of DM...
4- Less eating + more alcohol --> predisposition for Alcoholic Ketoacidosis.

then how is it DKA??

(question is from usmle.org free 150 questions of 2011. and the answer they hv given is DKA!)
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Old 07-26-2012
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Quote:
Originally Posted by mbbs2010 View Post
i thought so too.
but the answer is DKA..

now heres my confusion.

1- NORMAL potassium levels ----- goes highly AGAINST DKA.
2- Glucose levels --- NOT markedly elevated.
3- Nothing in the history going in favor of DM...
4- Less eating + more alcohol --> predisposition for Alcoholic Ketoacidosis.

then how is it DKA??

(question is from usmle.org free 150 questions of 2011. and the answer they hv given is DKA!)
Because in AKA the glucose levels should be low. I agree with you that the glucose level should be higher than 250 in DKA but I think there are many factors at play here which are affecting the glucose levels.

Quote:
In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.
Quote:
n 1940, Dillon and colleagues first described alcoholic ketoacidosis (AKA) as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting.

Last edited by Novobiocin; 07-26-2012 at 06:02 PM.
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Old 07-26-2012
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It's confusing but if I had to choose the best it would be DKA : at times it can be the first presentation of diabetes. Secondly they have mentioned beers only. That to 3-4 on weekdays and binge on weekends. AKA usually occurs in chronic alcoholics with excesssive consumption of alc. and not eating food. Pt. doesnt fit the profile for AKA
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Old 07-26-2012
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Quote:
Originally Posted by aman_j View Post
It's confusing but if I had to choose the best it would be DKA : at times it can be the first presentation of diabetes. Secondly they have mentioned beers only. That to 3-4 on weekdays and binge on weekends. AKA usually occurs in chronic alcoholics with excesssive consumption of alc. and not eating food. Pt. doesnt fit the profile for AKA

3-4 is alot / day on weekdays (max "safe" is 2), Binge = >5 drinks.

So, the man is definitely getting his drank on.
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Old 07-27-2012
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so heres the reasoning a friend n i came up with

1-patients with DKA. can for some time have normal K values before they eventually go up.

2-also in alcoholic patients with ketoacidosis.. K is LOW.

3-also Glucose levels of >=250 indicate DKA.
because with alcoholic ketoacidosis... glucose levels are LOW/NORMAL or MARGINALLY high.


source of the info--

http://emedicine.medscape.com/article/118361-overview
http://emedicine.medscape.com/article/116820-overview
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