Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis

Purpose: Diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) are t wo medical emergencies characterized by elevated total ketone body concentr ation. We aimed to determine differences in pathogenesis of ketoacidosis an d its metabolic consequences by comparing both at presentation and during t reatment, the different metabolic products and hormones involved in the ket oacidotic state. Materials and Methods: We studied 12 patients with DKA and 8 patients with AKA. On admission and every 4 hours for 24 hours during treatment, samples were drawn for determination of serum ketone bodies, lactate and pyruvate, insulin, and counterregulatory hormones (glucagon, cortisol, growth hormone , and catecholamines). Results: At presentation, with a similar P-hydroxybutyrate concentration, p atients with DKA had a higher plasma glucose (32 mmol/L vs. 6.6 mmol/L), lo wer beta-hydroxybutyrate/acetoacetate ratio (3:1 vs. 7:1), and a lower lact ate/pyruvate ratio (11:1 vs. 19:1) than patients with AKA tall, P < .01). T he mean time to resolve ketoacidosis in patients with AKA (6 +/- 1 hour) wa s significantly shorter than in patients with DKA (16 +/- 2 hours). At pres entation, the mean insulin concentration in patients with DKA and AKA were similarly decreased (7.8 +/- 2 and 10.3 +/- 3 mu U/mL, P = not significant [NS]). The mean glucagon level before therapy was 203 +/- 15 pg/mL and 188 +/- pg/mL for patients with DKA and AKA, respectively (P = NS). Levels of c ortisol, growth hormone, and epinephrine at presentation and during the fir st 8 hours of treatment were higher in patients with DKA; however, the diff erence in these values did not reach statistical significance. During thera py, levels of counterregulatory hormones declined at similar rates and retu rned to normal values after resolution of ketoacidosis. Conclusions: Our results indicate that, in addition to a history of diabete s or alcoholism, patients with DKA and AKA differ in their metabolic parame ters more than in their hormonal profile. The metabolic profile of DKA is c haracterized by a higher plasma glucose concentration, and lower P-hydroxyb utyrate to acetoacetate and lactate to pyruvate ratios compared with patien ts with AKA. The initial hormonal profile in both ketoacidotic states is ch aracterized by similarly decreased insulin levels and elevated levels of co unterregulatory hormones. Copyright (C) 2000 by W.B. Saunders Company.