Substance use: alcoholic ketoacidosis: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Substance use: alcoholic ketoacidosis

Sample item

A 40-year-old man who drinks heavily and has eaten little for three days presents with vomiting, abdominal pain and rapid breathing. The anion gap is raised, the blood glucose is low-normal, ketones are positive and the blood alcohol is nearly zero. What is the most appropriate initial treatment?

AIntravenous sodium bicarbonateBIntravenous dextrose-containing saline with thiamineCInsulin infusionDFomepizole

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous dextrose-containing saline with thiamine

Alcoholic ketoacidosis follows binge drinking with vomiting and starvation, and responds to glucose, saline and thiamine, which suppress ketogenesis. Insulin risks hypoglycaemia because glucose is not high, and thiamine should accompany glucose in drinkers.

Option by option

A. Intravenous sodium bicarbonate
Bicarbonate is rarely needed, and it does not address the cause of the acidosis.
B. Intravenous dextrose-containing saline with thiamine (correct)
Correct. Dextrose, fluids and thiamine reverse the ketosis.
C. Insulin infusion
Insulin is the treatment of diabetic ketoacidosis, and here it can precipitate hypoglycaemia.
D. Fomepizole
Fomepizole treats methanol and ethylene glycol poisoning, which is not suggested by ketosis and a history of starvation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Intravenous dextrose-containing saline with thiamine. Alcoholic ketoacidosis follows binge drinking with vomiting and starvation, and responds to glucose, saline and thiamine, which suppress ketogenesis.

Why is "Intravenous sodium bicarbonate" not the answer?

Bicarbonate is rarely needed, and it does not address the cause of the acidosis.

Why is "Insulin infusion" not the answer?

Insulin is the treatment of diabetic ketoacidosis, and here it can precipitate hypoglycaemia.

Why is "Fomepizole" not the answer?

Fomepizole treats methanol and ethylene glycol poisoning, which is not suggested by ketosis and a history of starvation.

What concept does this question test?

It tests Substance use: alcoholic ketoacidosis in Psychiatry. Insulin risks hypoglycaemia because glucose is not high, and thiamine should accompany glucose in drinkers.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Substance use: alcoholic ketoacidosis?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.