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Alcoholic ketoacidosis — MCCQE Part 1 MCQ

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HardAltered Level of ConsciousnessAlcoholic ketoacidosisMCCQE Part 1

A 48-year-old man with alcohol use disorder has vomiting after several days of poor intake. Glucose is 5.8 mmol/L, anion gap is high and ketones are positive. Which of the following is the most appropriate treatment?

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Correct answer: D — Thiamine and dextrose-containing fluids with electrolyte replacement

Alcoholic ketoacidosis often presents with normal or mildly elevated glucose after poor intake and vomiting. Treatment is thiamine, dextrose-containing fluids and electrolyte correction, which stimulates endogenous insulin. Insulin infusion is not routine and may cause hypoglycaemia.

Reference: Canadian emergency medicine toxicology practice; CAMH alcohol-related care resources