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논문분류	춘계학술대회 초록집
제목	Acute Necrotizing Esophagitis Associated with Extremely Severe Metabolic Acidosis Due to Alcoholic Ketoacidosis: A Case Report
저자	Ju Hwan Oh
출판정보	2026; 2026(1):
키워드	Acute necrotizing esophagitis, Alcoholic ketoacidosis, Severe metabolic acidosis
초록	Case Study: Acute necrotizing esophagitis (AEN), also known as black esophagus, is a rare condition characterized by diffuse circumferential necrosis of the esophageal mucosa and is most often associated with systemic hypoperfusion and severe metabolic derangements. We report a case of AEN associated with extremely severe metabolic acidosis due to alcoholic ketoacidosis. A 59-year-old man presented with hematemesis after heavy alcohol consumption and was found to have profound high–anion gap metabolic acidosis with extreme acidemia (arterial pH < 6.75), marked hyperlactatemia, hypotension, and acute kidney injury despite near-normal serum glucose levels. Alcoholic ketoacidosis was suspected, and aggressive supportive care was initiated in the intensive care unit. After hemodynamic and metabolic stabilization, esophagogastroduodenoscopy revealed diffuse circumferential esophageal necrosis consistent with AEN. Conservative management resulted in marked mucosal recovery without stricture formation on follow-up endoscopy. This case highlights that extremely severe metabolic acidosis associated with alcoholic ketoacidosis can be complicated by acute necrotizing esophagitis, a condition that nephrologists should be aware of in patients with profound acid–base disturbances and acute kidney injury, and underscores the importance of early systemic stabilization and appropriately timed endoscopic evaluation.
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