Not at hand. Try searching for "Atkins ketoacidosis Lancet" on Google
Scholar. If it isn't there now it will be by next week.

--Jenny

http://www.phlaunt.com/diabetes  Diabetes Info

http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood
Sugar Under Control

Note how they mention in passing that she was taking a "thermogenic"
formula.

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Woman admitted to hospital for ketoacidosis after following Atkins diet

March 16, 2006        Michael O'Riordan

New York, NY - An intriguing case report published in the Lancet this
week casts a shadow over the highly contentious Atkins diet [1]. In
February 2004, Dr Tsuh-Yin Chen (Lenox Hill Hospital, New York, NY)
and colleagues admitted a 40-year-old woman to the hospital for
ketoacidosis, presumably as a result of following the
low-carbohydrate, high-protein diet.

As noted by the doctors, ketones are produced in the liver whenever
there is a decrease in insulin during starvation. Low-carbohydrate
diets such as Atkins can lead to ketone production, they write, noting
that the Atkins diet book recommends regular monitoring for ketonuria
to confirm adherence to the diet.

On presentation to the emergency room, the patient was in moderate
distress. She had a respiratory rate of 20 to 30 breaths per minute,
along with hyperactive bowel sounds and mild epigastric
tenderness. The doctors note that the obese woman complained of
dyspnea and five days earlier her appetite had decreased. She also
felt nauseous and had since vomited four to six times daily.

She told doctors she had been strictly following the low-carbohydrate,
high-protein Atkins diet for the past month, eating primarily meat,
cheese, and salads. She also adhered to other Atkins recommendations,
taking multivitamins, omega-3 fatty acids, electrolytes, and extracts,
as well as a "thermogenic" formula. She reported a weight loss of 9 kg
over the one-month period.

Ketonuria confirmed

The doctors found her clinical examination to be relatively
unremarkable. The anion gap was high at 26 mmol/L and bicarbonate was
low at 8 mmol/L. Urine analysis confirmed ketonuria. She was admitted
to the ICU and given an infusion of dextrose and sodium
bicarbonate. She was discharged four days later and was without health
problems three and 18 months later when the doctors spoke with her on
the telephone.

Chen and colleagues note that a differential diagnosis of
high-anion-gap metabolic acidosis includes the ingestion of methanol,
ethylene glycol, or salicylate; L- or D-lactate acidosis; and
ketoacidosis due to diabetes mellitus, alcohol, or starvation. The
doctors ruled these other causes out, however. Serum was positive for
acetone, and -hydroxybutyrate was high at 390 µg/mL, consistent with
ketoacidosis.

"Our patient had an underlying ketosis caused by the Atkins diet and
developed severe ketoacidosis, possibly when her oral intake was
compromised from mild pancreatitis or gastroenteritis," conclude Chen
et al. "This problem may become more recognized because this diet is
becoming increasingly popular worldwide."

In a Comment [2], Drs Lyn Steffen and Jennifer Nettleton (University
of Minnesota, Minneapolis) write that while the Atkins diet boasts of
"good health," low-carbohydrate diets are far from healthy, given
their "association with ketosis, constipation or diarrhea, halitosis,
headache, and general fatigue, to name a few side effects."

They point out that diets increase the protein load to the kidney and
alter the body's acid balance. Moreover, long-term weight management
for at-risk individuals should be based on increased physical activity
and dietary modification, such as increasing intakes of whole grains,
fruit, and vegetables. The American Dietetic Association echoes this
weight-loss position, they note.