Chronic alcohol use can cause depleted hepatic glycogen stores and ethanol metabolism further impairs gluconeogenesis.

This can reduce glucose availability and lead to hypoglycemia and increased reliance on fatty acid and ketone metabolism.

[5] Ketoacidosis from starvation most commonly occurs in the setting of an additional metabolic stressor such as pregnancy, lactation, or acute illness.

As urgent medical treatment is often required when DKA is suspected, the tentative diagnosis can be made based on clinical history and by calculating the anion gap from the basic metabolic panel, which would demonstrate a high anion-gap metabolic acidosis along with high glucose levels.

This allows timely treatment with fluids and insulin well before direct serum ketone body testing results arrive.

Urine ketone testing is also available but this cannot easily distinguish DKA from other causes of ketonuria without more context.

Diagnostic workup should also include tests to determine any potential infectious trigger for DKA such as pneumonia or UTI.

Diabetic ketoacidosis is resolved with insulin infusion, intravenous fluids, electrolyte replacement and supportive care.

[2] Starvation ketoacidosis can be resolved with intravenous dextrose with attention to electrolyte changes that can occur with refeeding syndrome.

These populations are at risk of developing ketoacidosis in the setting of metabolic stressors such as fasting, low-carbohydrate diets, or acute illness.