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2017 ; 2017
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Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma
#MMPMID28924481
Rawla P
; Vellipuram AR
; Bandaru SS
; Pradeep Raj J
Endocrinol Diabetes Metab Case Rep
2017[]; 2017
(ä): ä PMID28924481
show ga
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.