2017
DOI: 10.2174/1573399812666160421121307
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Euglycemic Diabetic Ketoacidosis: A Review

Abstract: Euglycemic DKA thus poses a challenge to physicians, as patients presenting with normal BG levels in ketoacidosis may be overlooked, leading to a delay in appropriate management strategies. In this article, we review all the possible etiologies and the associated pathophysiology of patients presenting with euglycemic DKA. We also discuss the approach to diagnosis and management of such patients. Despite euglycemia, ketoacidosis in diabetic patients remains a medical emergency and must be treated in a quick and… Show more

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Cited by 184 publications
(180 citation statements)
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“…A worrisome increase in the incidence of admissions for diabetic ketoacidosis has occurred over the past two decades, with insulin omission and infection remaining the two predominant precipitating causes 121315. The introduction of the SGLT2 inhibitors has increased awareness of euglycemic diabetic ketoacidosis, which can occur with use of these agents as well as in other clinical situations 24. Educating patients to check urine or blood ketones in the presence of symptoms such as nausea, vomiting, and/or fatigue, even if blood glucose concentrations are below 11.1 mmol/L (200 mg/dL), is important as these symptoms may represent early warning signs for diabetic ketoacidosis 50…”
Section: Discussionmentioning
confidence: 99%
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“…A worrisome increase in the incidence of admissions for diabetic ketoacidosis has occurred over the past two decades, with insulin omission and infection remaining the two predominant precipitating causes 121315. The introduction of the SGLT2 inhibitors has increased awareness of euglycemic diabetic ketoacidosis, which can occur with use of these agents as well as in other clinical situations 24. Educating patients to check urine or blood ketones in the presence of symptoms such as nausea, vomiting, and/or fatigue, even if blood glucose concentrations are below 11.1 mmol/L (200 mg/dL), is important as these symptoms may represent early warning signs for diabetic ketoacidosis 50…”
Section: Discussionmentioning
confidence: 99%
“…Since the recent introduction of the SGLT2 inhibitors, several case reports and series describing euglycemic diabetic ketoacidosis in patients treated with these agents have been published 212223. The entity of euglycemic diabetic ketoacidosis is not limited to patients using SGLT2 inhibitors, however, as it has also been described in the setting of alcohol use disorders, pregnancy, and chronic liver disease 924…”
Section: Epidemiologymentioning
confidence: 99%
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“…Because of their unique mechanism of action, SGLT2 inhibitors are effective in lowering plasma glucose concentration as monotherapy and in combination with all other antidiabetic agents including insulin . Recent reports have demonstrated that some subjects receiving SGLT2 inhibitors experience clinically significant ketoacidosis events despite being normoglycaemic . These euglycaemic ketoacidotic events following SGLT2 administration were reported primarily in patients with type 1 diabetes, and in those with type 2 diabetes as well …”
Section: Introductionmentioning
confidence: 99%
“…DKA associated with SGLT 2 inhibitors usually does not have elevated blood glucose level due to persistent excretion of glucose in urine [4]. Euglycemic DKA is defined by anion gap metabolic acidosis (PH <7.3 and serum bicarbonate <18 mEq/L), presence of ketones in blood or urine and blood glucose <200 mg/dl [9]. The fall in the blood glucose level as glucose is lost in the urine decreases the insulin level in the body and increases glucagon level thus favoring gluconeogenesis and ketogenesis [10].…”
Section: Discussionmentioning
confidence: 99%