Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Clinical Manifestations of Patients with Severe Alcoholic Ketoacidosis Treated at a Medical Intensive Care Unit

한 내과계 중환자실에서 치료하였던 중증 알코올성 케톤산증 환자들의 임상적 특성

  • Lee, Kwang Ha (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sae Hwan (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Oh, Yeon-Mok (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lim, Chae-Man (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Koh, Yoonsuck (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Dong Soon (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Sang Bum (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 이광하 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 이세환 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 내과학교실)
  • Received : 2006.02.06
  • Accepted : 2006.04.25
  • Published : 2006.05.30
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Abstract

Background : Alcoholic ketoacidosis(AKA) is a metabolic disturbance that is caused by prolonged and excessive alcohol consumption. Though the prognosis is reportedly good, its outcome is unclear in some cases that are combined with multi-organ failure. There are few reports of an analysis of cases admitted to an intensive care unit(ICU) Method: Cases of AKA admitted to the ICU over the last 5 years were retrospectively analyzed. Severe AKA was characterized by multi-organ failure that required treatment in an ICU Results : All patients were males with a history of excessive alcohol consumption. Five of them (50%) mainly complained of gastrointestinal symptoms (nausea, vomiting, diarrhea), showing metabolic acidosis with an increased asmolar and anion gap. Rhabdomyolysis with acute renal failure was the most common combined organ failure. Mechanical ventilation was performed in 80%. Six patients died and 4 patients survived. In the surviving patients, the arterial blood gas analysis(ABGA) was normalized within 12 hours after admission. Conclusion : In severe AKA patients, rhabdomyolysis with acute renal failure was the most common complication. The mortality rate was high and death from shock occurred within 3 days.

연구배경 : 알코올성 케톤산증은 대부분 예후가 양호하나 여러 장기부전을 동반한 경우 중환자실 치 료가 필요하다. 이런 중증환자에 대한 보고가 부족하여 저자들은 중증 알코올성 케톤산증의 증례를 분석하였다. 방 법 : 2000년 1월 1일부터 2005년 6월 30일까지 서울아산병원 중환자실에서 입원하여 치료받았던 합병증을 가진 알코올성 케톤산증 10례를 선정하여 분석하였다. 결 과 : 모두 남자환자였고, 평균 나이는 $52.7{\pm}12.4$ 세, 평균 $20{\pm}13$년의 음주력이 있었다. 내원시 주증상은 복통,구토등의 소화기증상이 50%로 가장 많았다. 주요 검사실 소견상 Lactic acid (mmol/L) $57.89{\pm}55.35$, 동맥혈 pH $6.828{\pm}0.139$, Osmolar Gap (mOsm/L) $37.28{\pm}24.55$, Anion Gap (mOsm/L) $31.43{\pm}11.61$이었다. 동반된 주된 합병증으로 횡문근 융해증(80%), 패혈증(20%), 췌장염(10%) 순이었다. 70% 환자에서 투석이 80% 환자에서 기계환기가 실시되었다. 사망자 (60%) 들은 모두 3일이내에 쇼크로 인해서 사망하였다. 생존자들은 12시간안에 동맥혈 pH 7.15 이상으로 회복되었다. 결 론 : 중증 알코올성 케톤산증은 횡문근 융해증 및 급성 신부전이 주된 합병증으로 동반되며 사망률이 높다.

Keywords

References

  1. Sibai K, Eggimann P. Alcoholic ketoacidosis: not rare cause of metabolic acidosis. Rev Med Suisse 2005;1:2106, 2108-10, 2112-5
  2. Hojer J. Severe metabolic acidosis in the alcoholic: differential diagnosis and management. Hum Exp Toxicol 1996;15:482-8 https://doi.org/10.1177/096032719601500604
  3. Fulop M. Alcoholic ketoacidosis. Endocrinol Metab Clin North Am 1993;22:209-19
  4. Adams SL. Alcoholic ketoacidosis. Emerg Med Clin North Am 1990;8:749-60
  5. Duffens K, Marx JA. Alcoholic ketoacidosis: a review. J Emerg Med 1987;5:399-406 https://doi.org/10.1016/0736-4679(87)90146-6
  6. Palmer JP. Alcoholic ketoacidosis: clinical and laboratory presentation, pathophysiology and treatment. Clin Endoclinol Metab 1983;12:381-9 https://doi.org/10.1016/S0300-595X(83)80047-4
  7. Antri-Bonzar L, Lefevre G, Bonnard G, Khoury N, Rondeau E, Costa de Beauregard MA. A case of alcohol-induced ketoacidosis ? Ann Biol Clin 2005;63:335-8
  8. Tanaka M, Miyazaki Y, Ishikawa S, Matsuyama K. Alcoholic ketoacidosis associated with multiple complications: report of 3 cases. Intern Med 2004;43:955-9 https://doi.org/10.2169/internalmedicine.43.955
  9. Jain H, Beriwal S, Singh S. Alcohol induced ketoacidosis, severe hypoglycemia and irreversible encephalopathy. Med Sci Monit 2002;8:CS77-9
  10. Oosterheert JJ, van de Wiel A. Ketoacidosis after cessation of chronic alcohol consumption. Ned Tijdschr Geneeskd 2002;146:950-4
  11. Chie RW, Tai HL, Lam CW. Alcoholic ketoacidosis in two Chinese patients. Chin Med J 2000;113:1051-3
  12. Fulop M, Bock J, Ben-Ezra J, Antony M, Danzig J, Gage JS. Plasma lactate and 3-hydroxybutyrate levels in patients with acute ethanol intoxication. Am J Med 1986;80:191-4 https://doi.org/10.1016/0002-9343(86)90008-2
  13. Kim MJ, Lee HS, Kim KJ, Choung RS, Yim HJ, Lee SW, et al. Clinical characteristics of nontraumatic rhabdomyolysis in patients with liver cirrhosis. Korean J Gastroenterol 2005;46:218-25
  14. Qiu LL, Nalin P, Huffman Q, Sneed JB, Renshaw S, Hartman SW. Nontraumatic rhabdomyolysis with long-term alcohol intoxication. J Am Board Fam Pract 2004;17:54-8 https://doi.org/10.3122/jabfm.17.1.54
  15. Haas CE, Magram Y, Mishra A. Rhabdomyolysis and acute renal failure following an ethanol and diphenhydramine overdose. Ann Pharmacother 2003;37:538-42 https://doi.org/10.1345/aph.1C241
  16. Muthukumar T, Jha V, Sud A, Wanchoo A, Bambery P, Sakhuja V. Acute renal failure due to nontraumatic rhabdomyolysis following binge drinking. Ren Fail 1999;21:545-9 https://doi.org/10.3109/08860229909045195
  17. Moss M, Burnham EL. Chronic alcohol abuse, acute respiratory distress syndrome, and multiple organ dysfunction. Crit Care Med 2003;31:S207-12 https://doi.org/10.1097/01.CCM.0000057845.77458.25
  18. Cook RT. Alcohol abuse, alcoholism, and damage to the immune system: a review. Alcohol Clin Exp Res 1998;22:1927-42
  19. Gudis SM, Mangi S, Feinroth M, Rubin JE, Fredman EA, Berlyne GM. Rapid correction of severe lactic acidosis with massive isotonic bicarbonate infusion and simultaneous ultrafiltration. Nephron 1983;33:65-6 https://doi.org/10.1159/000182908