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Anion gap metabolic acidosis is often found in ED patients. It can be difficult to distinguish between toxic alcohol (TA) ingestion and alcoholic ketoacidosis (AKA). A retrospective study attempted to identify risk factors associated with AKA when TA ingestion was the alternative diagnosis.
New York City poison center data was reviewed from Jan 1, 2000 to April 30, 2019.
Case definition of AKA included
- Documented alcohol use disorder
- Urine or serum ketones or elevated blood beta-hydroxybutyrate concentration
- Anion gap >=14 mmol/L
Case definition of TA ingestion
- Detectable methanol or ethylene glycol concentration
Results
- 699 patients were screened.
- AKA diagnosis: 86
- TA ingestion: 36
Univariate analysis showed following variables to be associated with AKA diagnosis
- Ethanol level: OR 1.007 (95% CI: 1.001 – 1.013)
- Anion gap: OR 1.063 (95% CI: 1.007-1.122)
- Age (years): OR 1.036 (95% CI: 1.005 – 1.068)
Multivariate logistic regression showed elevated ethanol concentration was associated with increased odd of AKA diagnosis
Conclusion
- In this retrospective study, the odd of AKA diagnosis increased as ethanol concentration increased.
- TA ingestion remains challenging diagonsis without the availability of obtaining real time TA concentration.