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November 2, 1979, Vol 242, No. 18 >
ARTICLE | November 2, 1979

Causes of Hyperketonemia-Reply

David S. Schade, MD
JAMA. 1979;242(18):1968. doi:10.1001/jama.1979.03300180012011.
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In Reply.—  Dr Spencer is correct in that patients with ketonuria by the nitroprusside reaction may have ingested large quantities of isopropyl alcohol. Isopropyl alcohol is metabolized by alcohol dehydrogenase.1 A recent publication by Van de Graaf and Thompson2 indicates that isopropyl alcohol intoxication is not an uncommon clinical condition in a large community hospital. This cause of hyperketonemia should be added to the table in our article. Thus, isopropyl alcohol intoxication results in a positive nitroprusside reaction, a normal blood pH, and euglycemia; the treatment would be to remove isopropyl alcohol from the circulation. The fact that cyanide intoxication may also induce ketosis has been reported, but the mechanisms of this unusual event are less clear.

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