Severe Anion Gap Metabolic Acidosis From Isopropyl Alcohol and Alcoholic Ketoacidosis: A Diagnostic Challenge

Diabetic ketoacidosis, alcoholic ketoacidosis, and severe dehydration cause metabolic acidosis by exceeding the body's natural ability to neutralize excess acid.

When isopropyl alcohol is broken down into acetone in people who already have alcoholic ketoacidosis and reduced liver function, it can worsen acid-base imbalance by increasing ketone levels and osmolar gap.

A man with severe alcohol use disorder developed a severe metabolic acidosis with elevated levels of acetone and isopropanol after consuming isopropyl alcohol alongside alcohol, and this condition was rapidly reversed by hemodialysis.

Hemodialysis corrected severe metabolic acidosis and neurological depression in a patient with combined isopropyl alcohol toxicity and alcoholic ketoacidosis, even though standard medical guidelines did not indicate dialysis was needed for this condition.

In patients with severe metabolic acidosis and a history of alcohol use disorder, an osmolar gap above 37 mOsm/kg indicates the presence of isopropyl alcohol and acetone, even when methanol and ethylene glycol are not detected, and requires targeted testing for volatile alcohols if standard toxicology screens are negative.

In patients with alcohol use disorder and high levels of ketones and acid in the blood, the absence of high blood sugar and normal lactate levels identifies alcoholic ketoacidosis instead of diabetic ketoacidosis or lactic acidosis, but does not rule out poisoning from toxic alcohols like methanol or ethylene glycol.