Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. (4th September 2017)

• Record Type: Journal Article
• Authors: Rawla, Prashanth; Vellipuram, Anantha R; Bandaru, Sathyajit S; Pradeep Raj, Jeffrey
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2017)
• Publication Date: 2017-09-04
• Subjects: Adult -- Female -- White -- United States; Pancreas -- Diabetes -- Insulin -- Diabetes mellitus type 1 -- Diabetic ketoacidosis; Ketonuria -- Metabolic acidosis -- Diabetes mellitus type 1 -- Diabetic ketoacidosis -- Nausea -- Myasthaenia -- Appetite reduction/loss -- Dehydration -- Pyrexia -- Vaginal pain/tenderness -- Chills -- Vaginal dryness -- Sepsis -- Renal insufficiency -- Anion gap -- Glucose (blood) -- Urinalysis -- Lactate -- Bicarbonate -- Haemoglobin -- White blood cell count -- Potassium -- Chloride -- Creatinine (serum) -- Urea and electrolytes -- Ketones (urine) -- Glucose (urine) -- Leukocyte esterase (urine) -- Fluid repletion -- Insulin -- Insulin glargine -- Ceftriaxone; General practice -- Nephrology; Unique/unexpected symptoms or presentations of a disease -- September -- 2017; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-17-0081
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus, a high clinical suspicion is warranted, and other diagnosis ruled out. Here, we present two patients on regular insulin treatment who were admitted with a diagnosis of EDKA. The first patient had insulin pump failure and the second patient had urinary tract infection and nausea, thereby resulting in starvation. Both of them were aggressively treated with intravenous fluids and insulin drip as per the protocol for the blood glucose levels till the anion gap normalized, and the metabolic acidosis reversed. This case series summarizes, in brief, the etiology, pathophysiology and treatment of EDKA. Learning points: Euglycemic diabetic ketoacidosis is rare. Consider ketosis in patients with DKA even if their serum glucose levels are normal. High clinical suspicion is required to diagnose EDKA as normal blood sugar levels masquerade the underlying DKA and cause a diagnostic and therapeutic dilemma. Blood pH and blood or urine ketones should be checked in ill patients with diabetes regardless of blood glucose levels.