Diabetic Ketoacidosis in an Euglycemic Patient

Hassan, Mumtaz; Shafiq, Muhammad; Batool, Hajra; Naz, Tayyaba; Ambreen, Saima

doi:10.7759/cureus.10065

Cited by 3 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our case, the blood glucose was 218 mg/dL. Mumtaz H et al [ 10 ], in his case report of euglycemic DKA, reported that blood glucose in their case was only 84 mg/dL. In a retrospective case series by Menghoum N et al [ 12 ], the glycemia ranged from 112 to 280 mg/dL.…”

Section: Discussionmentioning

confidence: 50%

“…Each of them describes different precipitating factors compared to ours. These include pregnancy [ 9 ], urinary tract infection [ 10 ], surgery [ 11 ], dehydration and prolonged fasting [ 12 ]. In our scenario, acute stroke was the possible etiology, after which the patient was diagnosed with euglycemic DKA.…”

Section: Discussionmentioning

confidence: 99%

“…However, euglycemic DKA induced by SGLT-2 inhibitors in the presence of acute ischemic stroke is seldomly reported in the existing literature. The glycemic level is also variable throughout different studies [ 10 , 12 ]. In our case, the blood glucose was 218 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Euglycemic diabetic ketoacidosis in a patient with acute stroke taking sodium glucose co-transporter 2 inhibitor

Pathak¹,

Dhakal²,

Bhattarai³

et al. 2022

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Euglycemic diabetic ketoacidosis in a patient with acute stroke taking sodium glucose co-transporter 2 inhibitor

Pathak¹,

Dhakal²,

Bhattarai³

et al. 2022

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

“…SGLT2 inhibitors promote glucosuria leading to decreased plasma glucose level, which promotes glucagon production and discourages insulin release thereby inducing DKA with low blood glucose [1]. Reported median glucose levels range between 211 and 328 mg/dL [2,3]. DKA tends to have precipitating factors that cause stress in the body, such as preoperative and postoperative settings, sepsis, dehydration, and starvation [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

An Unsuspected Case of Euglycemic Diabetic Ketoacidosis With Twists

Kang¹,

Khamooshi²,

Pinzon³

2022

Cureus

View full text Add to dashboard Cite

Euglycemic diabetic ketoacidosis (EDKA) is defined by acidosis, ketones in serum and urine, and a high anion gap (AG) with a normal glucose level. Sodium-glucose cotransporter-2 (SGLT2) inhibitor has become one of the most common causes of EDKA. We present one of the lowest presenting blood glucose levels for the EDKA in the setting of SGLT2 inhibitor use. A 34-year-old female with a two-year history of type 2 diabetes mellitus (T2DM) presented after accidental ingestion of a metal clip and lack of oral intake for 28 hours. She reported a recent intentional weight loss of 60 lbs. She takes metformin 1000 mg twice daily and empagliflozin 25 mg daily. An urgent endoscopy was planned in the intensive care unit given the proximal location of the foreign body. The basic metabolic profile after the procedure demonstrated a glucose level of 75 mg/dL, bicarbonate level of 11 mmol/L, and AG of 17 mmol/L. The venous pH was 7.27 with a partial pressure of carbon dioxide of 30 mmHg. The urinalysis showed a glucose level greater than 500 μmol/L with a ketone level of 80 μmol/L. The blood and urine toxicology screening results were unremarkable. The patient was treated for EDKA with the administration of intravenous (IV) dextrose 5% in water with subsequent initiation of IV insulin. The assessment of her insulin reserve revealed a low C-peptide of 0.36 ng/mL, a high glutamic acid decarboxylase level greater than 250 IU/mL, and high zinc transporter 8 (ZnT8) antibodies of 42 U/mL, consistent with an undiagnosed transition to latent autoimmune diabetes in adults (LADA). The blood glucose levels for previously reported cases remain between 90 and 250 mg/dL. In this case, the combination of a low carbohydrate diet and prolonged starvation may have led to the impressively low glucose. Additionally, the SGLT2 inhibitor use in patients with LADA serves as one of the known risk factors for EDKA. EDKA poses a diagnostic challenge, especially in the ICU setting where there exists a myriad of causes for high AG metabolic acidosis. Additionally, many of the ICU patients are in a ketotic state brought on by prolonged starvation. Therefore, prompt diagnosis and treatment for EDKA require careful history taking and complete investigation for other causes of high AG metabolic acidosis.

show abstract

Extraabdominal Causes of Abdominal Pain

SEZGIN

Karcıoğlu

YENİOCAK³

et al. 2022

Abdominal Pain: Essential Diagnosis and Management in Acute Medicine

View full text Add to dashboard Cite

Diabetes mellitus (DM), chronic renal failure (CRF), amyloidosis, sickle cell anemia (SCA) and acute intermittent porphyria are among diseases that can be associated with abdominal pain (AP) at some point in the course of the pathological process. Diabetic ketoacidosis (DKA) is a severe life-threatening syndrome characterized by fluid loss, electrolyte changes, hyperosmolarity and acidosis. These pathophysiologic factors can explain AP in patients with DKA. Vomiting and AP can also be initial manifestations of DKA even in euglycemic patients. SCA is one of the most common autosomal recessive diseases classified in hemoglobinopathies. The disease is first recognized by history, then by peripheral smear and hemoglobin electrophoresis, and advanced studies. Splenic sequestration crisis is a severe complication of SCA that prompts emergent treatment, Opiate analgesia and hydration is the main treatment. Patients with chronic renal failure (CRF) and end-stage renal disease are also prone to severe AP due to peritonitis which is triggered by continuous ambulatory peritoneal dialysis in vulnerable patients. Amyloidosis is mostly recognized with typical attacks i.e., febrile episodes, exanthema, AP, myalgias and arthralgias. Acute intermittent porphyria is an autosomal dominant disorder characterized by severe neurovisceral attacks of AP, nausea, vomiting, tachycardia, and hypertension in the absence of signs compatible with peritonitis. Management of mild attacks comprises symptomatic treatment, optimized calorie intake, and fluid replacement to beware dehydration.

show abstract

Diabetic Ketoacidosis in an Euglycemic Patient

Cited by 3 publications

References 14 publications

Euglycemic diabetic ketoacidosis in a patient with acute stroke taking sodium glucose co-transporter 2 inhibitor

Euglycemic diabetic ketoacidosis in a patient with acute stroke taking sodium glucose co-transporter 2 inhibitor

An Unsuspected Case of Euglycemic Diabetic Ketoacidosis With Twists

Extraabdominal Causes of Abdominal Pain

Contact Info

Product

Resources

About