Endocrine Abstracts

Background: Starvation ketoacidosis (SKA) represents one of three metabolic acidosis caused by the accumulation of ketone bodies in blood. While easily treated, it is a diagnosis that can be easily mimic diabetic ketoacidosis, particularly in the presence of hyperglycemia¹.

Case: We report a 54-year old female, who had been feeling unwell with ongoing nausea and vomiting, and not eating nor drinking for 5 days. She had a history of alcohol excess but had abstained for some time prior admission, and had an anxiety and depression. Regular medication included mirtazapine and propranolol. Her BM was found 21.8 mmol with positive ketones in urine. Venous blood gas revealed metabolic acidosis. Diagnosis of diabetic ketoacidosis with new onset of diabetes and possible SKA were made. She was managed using the local DKA protocol and saw prompt resolution of her acidosis. This patient also received IV thiamine due to concerns regarding overlap of alcoholic ketoacidosis (AKA). As a result, her HbA1c was 34 mmol and anti GAD antibodies were negative. Thus, DKA was ruled out, and diagnosis of starvation ketoacidosis was finally made.

Conclusion: SKA represents raised anion gap metabolic acidosis caused by the accumulation of ketone bodies in the blood and normal or low glucose levels. The other two causes of a ketoacidosis are alcoholic ketoacidosis and the much more common diabetic ketoacidosis as it was previously thought in this case. As, our patient had severe hyperglycemia, which misdirected us to DKA. Thus importantly consider checking HbA1c to confirm DKA.

Reference: 1. Gall AJ, Duncan R, Badshah A. Starvation ketoacidosis on the acute medical take. Clin Med (Lond). 2020 May;20(3):298-300. doi: 10.7861/clinmed.2020-0012. PMID: 32414718; PMCID: PMC7354049.