Alcoholic Ketoacidosis Accompanied by Acute Gastric Dilation in a Patient with type 2 Diabetes on an SGLT2 Inhibitor and Chronic Alcoholic Abuse

A 45-year-old male was admitted to our hospital with complaints of nausea, vomiting, and abdominal pain for the past two days. He had been receiving treatment for diabetes for 6 years. Two weeks before hospitalization, despite experiencing a loss of appetite and difficulty in eating, he continued drinking alcohol. Canagliflozin and metformin were discontinued concurrently. Laboratory findings revealed high anion gap metabolic acidosis due to elevated serum ketone bodies and mild hyperglycemia. Alcohol ketoacidosis was diagnosed on the basis of a history of excessive alcohol intake and an increased osmolarity gap. Abdominal computed tomography (CT) revealed distension of the stomach with no obstructing mass.