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Non-diabetic ketoacidosis: a case series and literature review
  1. Bilal Bashir1,2,
  2. Ahmed A Fahmy2,
  3. Farheen Raza2,
  4. Moulinath Banerjee1,3
  1. 1 Endocrinology, Diabetes and Specialist Weight Management, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
  2. 2 Endocrinology and Diabetes, East Lancashire Hospitals NHS Trust, Blackburn, UK
  3. 3 Centre for Endocrinology and Diabetes, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
  1. Correspondence to Bilal Bashir, Department of Diabetes, Endocrinology and Specialist Weight Management, Bolton NHS Foundation Trust, Bolton BL4 0JR UK; Bilalbashir118{at}


The genesis of ketone bodies by organisms is a protective mechanism. This metabolic process helps organisms to survive acute metabolic derangements in times of nutrient deficiency. When prolonged, ketogenesis leads to ketoacidosis, which is a potentially life-threatening metabolic disorder due to the accumulation of keto-acids in the body. The most common cause is diabetic ketoacidosis, though starvation ketoacidosis and alcoholic ketoacidosis are not uncommon. The presentation of all ketoacidotic states is similar—being generally unwell, abdominal pain, rapid and shallow breathing, vomiting and dehydration. Non-diabetic ketoacidotic states are very commonly overlooked due to relative unawareness among the clinicians, leading to misdiagnosis and thereby inappropriate management culminating in added mortality and morbidity. We describe here six cases of alcoholic and starvation ketoacidosis, review the literature currently available and discuss the common pitfalls in managing such cases.

  • Diabetes & endocrinology
  • other metabolic (eg iron, porphyria)

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  • Contributors BB: case collection, writing – original draft, writing – review and editing, visualisation. FR: writing – review and editing. AAF: writing – review and editing. MB: conceptualisation, writing – review and editing, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Consent obtained directly from patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.