Ketoacidosis due to a Low-carbohydrate Diet in an Elderly Woman with Dementia and Abnormal Eating Behavior

Intern Med. 2017 Oct 1;56(19):2671-2675. doi: 10.2169/internalmedicine.8689-16. Epub 2017 Sep 6.


Strict restriction of carbohydrates can induce symptomatic ketoacidosis. We herein report a 76-year-old demented woman who developed ketoacidosis after 1 month of abnormal eating behavior involving selectively eating hamburger steak (estimated carbohydrate =12.7 g/day). Laboratory tests showed high-anion-gap metabolic acidosis with elevated blood ketone levels. She was successfully treated with intravenous fluids followed by oral intake of a regular diet. She remained relapse-free after correcting her eating habits. Healthcare providers should know that abnormal eating behavior in demented people can lead to an extremely-low-carbohydrate diet and cause atypical ketoacidosis unexplained by diabetes, heavy alcohol intake, or starvation conditions.

Keywords: abnormal eating behavior; dementia; ketoacidosis; low carbohydrate diet.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Dementia
  • Diet, Carbohydrate-Restricted / adverse effects*
  • Feeding Behavior
  • Female
  • Humans
  • Ketosis / etiology*
  • Ketosis / therapy*
  • Starvation / complications*
  • Starvation / therapy*
  • Treatment Outcome