We report herein 6 cases of sudden cardiac arrest in alcoholic ketoacidosis (AKA). All cases displayed evidence of prolonged excessive alcohol consumption and elevated beta-hydroxybutyric acid levels and exhibited pulseless electrical activity (PEA) upon collapse. Severe metabolic acidosis was also seen in all cases. Some cases also displayed concomitant respiratory acidosis, hypothermia, hypoxia and/or hemorrhage. No evidence of myocardial infarction, tamponade or right heart strain, which would suggest pulmonary embolism, was found on cardiac ultrasonography. As PEA in AKA is induced by severe metabolic acidosis, aggressive correction of acidosis may represent a useful therapeutic strategy for such patients.