Differential diagnosis of ketoacidosis in hyperglycemic alcoholic diabetic patient: The role of insulin

Abstract

It is important to differentiate between diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) in an alcoholic diabetic patient since it has significant management implications. Ketoacidosis in an alcoholic diabetic patient is a diagnostic challenge as both these clinical entities have metabolic acidosis with high anion gap. Most patients with DKA have hyperglycemia. The majority of AKA patients present with normal or low glucose levels; however, AKA may also present with high glucose levels, more so in diabetics. The situation becomes quite perplexing when an alcoholic diabetic patient presents with hyperglycemia since it can be attributed to DKA or AKA.