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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

References