TY - JOUR A2 - Korzets, Ze’ev AU - Rana, Abdul Mughees AU - Mansoor, Kannan AU - Assad, Salman AU - Abouzid, Mahmoud AU - Ogu, Iheanyichukwu AU - Bandak, Ghassan Salim Issa PY - 2020 DA - 2020/09/15 TI - Severe Metabolic Acidosis: A Case of Triple Hit with Ketogenic Diet, Vinegar, and Metformin in an Obese Patient SP - 8861978 VL - 2020 AB - Obesity is an epidemic with high burden of disease. It is directly proportional to increased risk of morbidity and mortality. Ketogenic diet and herbal supplements have recently gained popularity amongst patients struggling with weight loss. There are limited data available for most of these supplements contrary to the claims laid by the mainstream media. Due to lack of awareness, this patient population is at high risk of adverse effects. We present a case of severe acidosis secondary to ketogenic diet and acetic acid (vinegar) ingestion. The use of dietary acetic acid is usually well tolerated; however, in this case, the large quantities and presence of acute renal injury and metformin use may have worsened the acidosis. Severe ketosis in setting of ketogenic diets is a serious complication, which is infrequently reported in literature. Many of these diets and supplements may seem harmless, but as our case illustrates, when combined with other risk factors, patients can face serious adverse effects and even require hospitalization. It is imperative that such dietary practices are physician supervised to avoid complications. With the recent surge of over-the-counter weight loss supplements and ketogenic diets, physicians also need to engage in dietary discussion with patients when attempting to lose weight. SN - 2090-6641 UR - https://doi.org/10.1155/2020/8861978 DO - 10.1155/2020/8861978 JF - Case Reports in Nephrology PB - Hindawi KW - ER -