In ethanol intoxication with ketosis, which therapy addresses ketosis?

• A. Glucose administration
• B. Insulin infusion
• C. Fomepizole
• D. Dialysis

Answer: (A)

In this scenario, the key problem is alcoholic ketoacidosis, where ketosis results from low insulin and a high NADH state after ethanol metabolism, leading to unchecked fat breakdown and ketone production. Giving glucose provides rapid substrate to raise blood sugar and, importantly, stimulates endogenous insulin release. The rise in insulin shuts down hormone-sensitive lipase in fat tissue, reducing the release of free fatty acids into the liver and halting further ketone production. At the same time, glucose supports hepatic metabolism toward glycolysis and glycogen synthesis, helping correct hypoglycemia and resolve the ketosis.

Fomepizole targets toxic alcohols like methanol or ethylene glycol, not ketosis. Dialysis can help in severe toxin states or acidosis but doesn’t specifically stop the ongoing ketone production in alcoholic ketoacidosis. Insulin infusion can suppress ketosis, but the standard initial management emphasizes glucose-containing fluids to safely raise glucose and stimulate endogenous insulin before considering other measures.