RT Journal Article SR Electronic T1 Starvation ketoacidosis on the acute medical take JF Clinical Medicine JO Clin Med FD Royal College of Physicians SP 298 OP 300 DO 10.7861/clinmed.2020-0012 VO 20 IS 3 A1 Alexander J Gall A1 Robert Duncan A1 Amit Badshah YR 2020 UL http://www.rcpjournals.org/content/20/3/298.abstract 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.