Massive lactic acidosis and ketoacidosis with glucagon deficiency in a chronic alcoholic patient.

Boudou, Philippe Djibré, Michel Ibrahim, Fidaa Fellahi, Soraya Gilon, Patrick [UCL] Andreelli, Fabrizio Ferré, Pascal Boissan, Mathieu et al.[show all]

A non-diabetic chronic alcoholic and undernourished male patient [body mass index (BMI): 16.6 kg/m2] was admitted to our hospital emergency department. He had fasted for the previous 3 days. His blood lactate and ketone body concentrations were massively elevated (18 mmol/L and 14 mmol/L, respectively). Ethanolaemia was negative. Massive metabolic acidosis was noted with a pH of 7.04. Renal function remained normal, but there was mild hepatocellular deficiency and no acute pancreatitis. The patient was hypoglycaemic at admission with a blood glucose level of 3.0 mmol/L, and low concentrations of insulin, C-peptide and insulin-like growth factor (IGF)-1, as well as very low glucagon concentrations (5.2 ng/L; normal range: 8–74 ng/L) despite the prevailing glycaemia. In contrast, cortisol, sex hormone-binding globulin (SHBG) and growth hormone (GH) concentrations were elevated. [...]