{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:12:52Z","timestamp":1787497972107,"version":"build-2736575974"},"reference-count":45,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[1996,6,1]],"date-time":"1996-06-01T00:00:00Z","timestamp":833587200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hum Exp Toxicol"],"published-print":{"date-parts":[[1996,6]]},"abstract":"<jats:p>1 A chronic alcoholic with severe metabolic acidosis presents a difficult diagnostic problem. The most common cause is alcoholic ketoacidosis, a syndrome with a typical history but often misleading laboratory findings. This paper will focus on this important and probably underdiagnosed syndrome.<\/jats:p>\n                  <jats:p>2 The disorder occurs in alcoholics who have had a heavy drinking-bout culminating in severe vomiting, with resulting dehydration, starvation, and then a \u03b2- hydroxybutyrate dominated ketoacidosis.<\/jats:p>\n                  <jats:p>3 Awareness of this syndrome, thorough history-taking, physical examination and routine laboratory analyses will usually lead to a correct diagnosis.<\/jats:p>\n                  <jats:p>4 The treatment is simply replacement of fluid, glucose, electrolytes and thiamine. Insulin or alkali should be avoided.<\/jats:p>\n                  <jats:p>5 The most important differential diagnoses are diabetic ketoacidosis, lactic acidosis and salicylate, methanol or ethylene glycol poisoning, conditions which require quite different treatment.<\/jats:p>\n                  <jats:p>6 The diagnostic management of unclear cases should always include toxicological tests, urine microscopy for calcium oxalate crystals and calculation of the serum anion and osmolal gaps.<\/jats:p>\n                  <jats:p>7 It is suggested here, however, that the value of the osmolal gap should be considered against a higher reference limit than has previously been recom mended. An osmolal gap above 25 mosm\/kg, in a patient with an increased anion gap acidosis, is a strong indicator of methanol or ethylene glycol intoxication.<\/jats:p>","DOI":"10.1177\/096032719601500604","type":"journal-article","created":{"date-parts":[[2008,12,24]],"date-time":"2008-12-24T01:08:04Z","timestamp":1230080884000},"page":"482-488","source":"Crossref","is-referenced-by-count":36,"title":["Severe metabolic acidosis in the alcoholic: differential diagnosis and management"],"prefix":"10.1177","volume":"15","author":[{"given":"Jonas","family":"H\u00f6jer","sequence":"first","affiliation":[{"name":"Department of Medicine, S\u00f6der Hospital, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[1996,6,1]]},"reference":[{"key":"atypb1","first-page":"1813","volume":"24","author":"Dillon ES","year":"1940","journal-title":"America"},{"key":"atypb2","doi-asserted-by":"publisher","DOI":"10.2337\/diab.23.5.433"},{"key":"atypb3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.292.6518.463"},{"key":"atypb4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1971.03190020037007"},{"key":"atypb5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.1986.tb05154.x"},{"key":"atypb6","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-595X(83)80047-4"},{"key":"atypb7","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(91)90003-G"},{"key":"atypb8","first-page":"209","volume":"22","author":"Fulop M.","year":"1993","journal-title":"America"},{"key":"atypb9","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-197756010-00002"},{"key":"atypb10","doi-asserted-by":"publisher","DOI":"10.1016\/0736-4679(87)90146-6"},{"key":"atypb11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-78-2-213"},{"key":"atypb12","unstructured":"McGarry JD, Foster DW Diabetic ketoacidosis. 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