{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:07:42Z","timestamp":1772608062263,"version":"3.50.1"},"reference-count":14,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,21]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Starvation ketoacidosis (SKA) is a rarer cause of ketoacidosis. Most patients will only have a mild acidosis, but if exacerbated by stress can result in a severe acidosis. We describe a 66-year-old man admitted with reduced consciousness and found to have a severe metabolic acidosis with raised anion gap. His body mass index (BMI) was noted to be within the healthy range at 23 kg\/m<jats:sup>2<\/jats:sup>; however, it was last documented 1 year previously at 28 kg\/m<jats:sup>2<\/jats:sup> with no clear timeframe of weight loss. While his acidosis improved with intravenous fluids, he subsequently developed severe electrolyte imbalance consistent with refeeding during his admission. Awareness of SKA as a cause for high anion gap metabolic acidosis is important and knowledge of management including intravenous fluids, thiamine, dietetic input and electrolyte replacement is vital.<\/jats:p>","DOI":"10.1136\/bcr-2021-245065","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T11:51:50Z","timestamp":1638964310000},"page":"e245065","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Starvation ketoacidosis and refeeding syndrome"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8915-3841","authenticated-orcid":false,"given":"Angela Heulwen","family":"Boal","sequence":"first","affiliation":[{"name":"Department of Clinical Biochemistry, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Panarelli","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Millar","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"2025082700205149000_14.12.e245065.1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1056\/NEJMc052709","article-title":"Ketoacidosis during a low-carbohydrate diet","volume":"354","author":"Shah","year":"2006","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082700205149000_14.12.e245065.2","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.2169\/internalmedicine.8689-16","article-title":"Ketoacidosis due to a low-carbohydrate diet in an elderly woman with dementia and abnormal eating behavior","volume":"56","author":"Iwata","year":"2017","journal-title":"Intern Med"},{"key":"2025082700205149000_14.12.e245065.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-595X(83)80046-2"},{"key":"2025082700205149000_14.12.e245065.4","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1159\/000517305","article-title":"Starvation ketosis and the kidney","volume":"52","author":"Palmer","year":"2021","journal-title":"Am J Nephrol"},{"key":"2025082700205149000_14.12.e245065.5","doi-asserted-by":"publisher","DOI":"10.1002\/dmr.5610050304"},{"key":"2025082700205149000_14.12.e245065.6","doi-asserted-by":"crossref","first-page":"e22.1","DOI":"10.1016\/j.ajkd.2003.07.012","article-title":"Severe acidosis caused by starvation and stress","volume":"42","author":"Toth","year":"2003","journal-title":"Am J Kidney Dis"},{"key":"2025082700205149000_14.12.e245065.7","doi-asserted-by":"publisher","DOI":"10.1381\/096089204323013613"},{"key":"2025082700205149000_14.12.e245065.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(12)80701-3"},{"key":"2025082700205149000_14.12.e245065.9","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198001000-00008"},{"key":"2025082700205149000_14.12.e245065.10","first-page":"163","article-title":"Hormonal regulation of ketone-body metabolism in man","volume":"43","author":"Alberti","year":"1978","journal-title":"Biochem Soc Symp"},{"key":"2025082700205149000_14.12.e245065.11","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197410000-00031"},{"key":"2025082700205149000_14.12.e245065.12","doi-asserted-by":"publisher","DOI":"10.1002\/eat.10055"},{"key":"2025082700205149000_14.12.e245065.13","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2011.011185"},{"key":"2025082700205149000_14.12.e245065.14","doi-asserted-by":"crossref","DOI":"10.3390\/jcm8122202","article-title":"Management of refeeding syndrome in medical inpatients","volume":"8","author":"Reber","year":"2019","journal-title":"J Clin Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-245065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:21:03Z","timestamp":1756279263000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-245065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":14,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,8]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bcr-2021-245065"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-245065","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}