Since standard nitroprusside tests measure only AcAc, ketosis may paradoxically appear to worsen as patients improve, due to conversion of BOHB to measurable AcAc over time. Since the patient may have stopped oral intake days before presentation odor of alcohol on the breath is usually absent and the ethanol level may be zero. Starvation ketosis - diagnosis depends mainly on history and physical examination. Salicylate intoxication - clinical signs may include GI upset and tinnitus. Seizures and GI bleeding may occur.
Metabolic acidosis is most common in pediatric overdose.
Pure respiratory alkalosis may occur early in adults and because of the vigorous respiratory response, mixed metabolic acidosis and respiratory alkalosis are common in both groups. Laboratory studies may show hypoglycemia, hyperthermia, and impaired blood clotting. Early presentation may resemble diabetic ketoacidosis or hyperglycemia. History of ingestion and salicylate levels are the key to definitive diagnosis. Lactic acidosis - elevated lactate levels help confirm this diagnosis.