KETOACIDOSIS AND LACTIC-ACIDOSIS - FREQUENT CAUSES OF DEATH IN CHRONIC-ALCOHOLICS

In clinical medicine, severe keto- or lactic adicosis associated with vomiting, nausea, abdominal pain, tachycardia or pathological respirat ion, has been described in chronic alcoholics. This study reports on f atalities of chronic alcoholics where the cause of death could not be determined by thorough autopsy, histology and toxicology including det ermination of alcohol concentration. In a first series, acetone was de termined in the blood of such chronic alcoholics (n = 24), diabetics w ith metabolic decompensation (n = 7), cases of hypothermia (il = 7) an d controls (n = 218). Among the 24 chronic alcoholics where the cause of death was unknown, 9 cases showed very high levels of acetone (74-4 00 mg/l). These comprised 6 cases without additional findings and 3 ca ses where a second patho-mechanism such as intoxication possibly contr ibuted to the cause of death. In a second series, the sum values accor ding to Traub (lactate/glucose) were determined in cerebrospinal liquo r of chronic alcoholics with undetermined cause of death (n = 45), dia betics (n = 6) and controls (n = 39). Among the 45 alcoholics, 17 case s showed very high sum values (294-594 mg/dl) including 8 cases where non-lethal intoxications may have contributed to the final outcome. Ot her causes of a ketoacidosis or lactic acidosis (e.g. diabetes) were e xcluded in both groups of alcoholics. Consequently, ketoacidosis and l actic acidosis can be the cause of death of chronic alcoholics in a co nsiderable number of cases where no pathomorphological or toxicologica l changes are present. A scheme for medical and laboratory examination is described.