{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T04:03:38Z","timestamp":1746245018398,"version":"3.40.4"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2014,4,28]],"date-time":"2014-04-28T00:00:00Z","timestamp":1398643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Basic Clin Pharma Tox"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>An intoxication with drugs, ethanol or cleaning solvents may cause a complex clinical scenario if multiple agents have been ingested simultaneously. The situation can become even more complex in patients with (multiple) co\u2010morbidities. A 59\u2010year\u2010old man with type 2 diabetes mellitus (without treatment two weeks before the intoxication) intentionally ingested a substantial amount of ethanol along with ~750<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>of laminate floor cleaner containing citric acid. The patient was admitted with severe metabolic acidosis (both ketoacidosis and lactic acidosis, with serum lactate levels of 22\u00a0mM). He was treated with sodium bicarbonate, insulin and thiamine after which he recovered within two days. Diabetic ketoacidosis and lactic acidosis aggravated due to ethanol intoxication, thiamine deficiency and citrate. The high lactate levels were explained by excessive lactate formation caused by the combination of untreated diabetes mellitus, thiamine deficiency and ethanol abuse. Metabolic acidosis in diabetes is multi\u2010factorial, and the clinical situation may be further complicated, when ingestion of ethanol and toxic agents are involved. Here, we reported a patient in whom diabetic ketoacidosis was accompanied by severe lactic acidosis as a result of citric acid and mainly ethanol ingestion and a possible thiamine deficiency. In the presence of lactic acidosis in diabetic ketoacidosis, physicians need to consider thiamine deficiency and ingestion of ethanol or other toxins.<\/jats:p>","DOI":"10.1111\/bcpt.12251","type":"journal-article","created":{"date-parts":[[2014,4,10]],"date-time":"2014-04-10T07:05:39Z","timestamp":1397113539000},"page":"472-475","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe Lactic Acidosis in a Diabetic Patient after Ethanol Abuse and Floor Cleaner Intake"],"prefix":"10.1111","volume":"115","author":[{"given":"Jeroen J. M. A.","family":"Hendrikx","sequence":"first","affiliation":[{"name":"Department of Pharmacy &amp; Pharmacology Slotervaart Hospital Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurjen S.","family":"Lagas","sequence":"additional","affiliation":[{"name":"Department of Pharmacy &amp; Pharmacology Slotervaart Hospital Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ratana","family":"Daling","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Slotervaart Hospital Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Hendrik","family":"Hooijberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Hematology Slotervaart Hospital Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan H. 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