Related Subjects: |Metabolic acidosis |Type 1 DM | Type 2 DM | Diabetes in Pregnancy | HbA1c | Diabetic Ketoacidosis (DKA) Adults | Hyperglycaemic Hyperosmolar State (HHS) | Diabetic Nephropathy | Diabetic Retinopathy | Diabetic Neuropathy | Diabetic Amyotrophy | Maturity Onset Diabetes of the Young (MODY) | Diabetes: Complications
The normal glucose may lead to misdiagnosis and under treatment called euglycaemic ketoacidosis
About
- A rare but important scenario as can be life-threatening
- May be seen in those with Type 1 DM
Precipitants
- Alcohol or other drug intake, Insulin reduction, Increased SGLT2
- Low CHO or ketogenic diet, Pregnancy, Previous DKA
- Acute infection, dehydration, vigorous exercise
Findings
- Hyperglycaemia: The glucose may be normal or slightly raised. Levels may be = 13.9 mmol/L or 250 mg/dL
- Metabolic acidosis with increased anion gap HCO3 = 15 mmol/L or pH = 7.3
- Ketones Beta hydroxybutyrate = 3 mmol/L
Clinical
- Polyuria, polydipsia, polyuria, dehydration
- Abdominal pain, malaise, dizziness, syncope
Investigations
- FBC, U&E, Bone, CRP, Glucose, Ketones, VBG
- CXR if chest symptoms or signs
- Blood and urine culture if septic
Management
- Take early expert endocrine consult
- ABC, IV fluids, immediately stop SGLT2 inhibitor
- Rehydration. Give fluids and carbohydrate. Bolus insulin
Prevention
- Long term avoid precipitant and watch ketone levels
- Stop SGLT2 inhibitors during acute illness