PT - JOURNAL ARTICLE AU - Alexander J Gall AU - Robert Duncan AU - Amit Badshah TI - Starvation ketoacidosis on the acute medical take AID - 10.7861/clinmed.2020-0012 DP - 2020 May 01 TA - Clinical Medicine PG - 298--300 VI - 20 IP - 3 4099 - http://www.rcpjournals.org/content/20/3/298.short 4100 - http://www.rcpjournals.org/content/20/3/298.full SO - Clin Med2020 May 01; 20 AB - Starvation ketoacidosis (SKA) represents one of three metabolic acidoses caused by the accumulation of ketone bodies within the bloodstream. While easily treated, it is a diagnosis that can be easily missed in patients with an unexplained metabolic acidosis.In this case report, we discuss two patients presenting with a starvation ketoacidosis and psychiatric illness. This link between SKA and psychiatric disease is especially pertinent as this is a cohort of patients who may not be able to give an accurate history, which can potentially lead to a delay in diagnosis and treatment.Furthermore, the patient cohort described here have higher rates of alcohol dependence and are therefore at risk of alcoholic ketoacidosis. It is important to recognise that these conditions may coexist and should be managed as such, with thiamine prior to carbohydrate replacement in all at-risk patients.