Euglycemic ketoacidosis induced by therapeutic fasting in a non-diabetic patient

Larroumet, Alice; Camoin, Marion; Foussard, Ninon; Alexandre, L.; Mesli, Samir; Redonnet, Isabelle; Baillet-Blanco, Laurence; Rigalleau, Vincent; Mohammedi, Kamel

doi:10.1016/j.nut.2019.110668

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…When ketone consumption decreases, it results in ketosis, which can be clinically evident by elevated blood concentrations of ketone bodies (β‐hydroxybutyrate, acetoacetate and acetone) 9 . Ketoacidosis, a severe metabolic disorder characterized by the accumulation of ketone bodies and acidosis, is mostly seen in people with diabetes and is rarely induced by other pathological conditions 10 . In the present study, 42 patients with COVID‐19 had ketosis, including 27 who did not have diabetes.…”

Section: Discussionmentioning

confidence: 60%

COVID‐19 infection may cause ketosis and ketoacidosis

Xiu-fang

Chen

et al. 2020

Diabetes Obesity Metabolism

461

465

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The present study included 658 hospitalized patients with confirmed COVID‐19. Forty‐two (6.4%) out of 658 patients presented with ketosis on admission with no obvious fever or diarrhoea. They had a median (interquartile range [IQR]) age of 47.0 (38.0–70.3) years, and 16 (38.1%) were men. Patients with ketosis were younger (median age 47.0 vs. 58.0 years; P = 0.003) and had a greater prevalence of fatigue (31.0% vs. 10.6%; P < 0.001), diabetes (35.7% vs. 18.5%; P = 0.007) and digestive disorders (31.0% vs. 12.0%; P < 0.001). They had a longer median (IQR) length of hospital stay (19.0 [12.8–33.3] vs. 16.0 [10.0–24.0] days; P < 0.001) and a higher mortality rate (21.4% vs. 8.9%; P = 0.017). Three (20.0%) out of the 15 patients with diabetic ketosis developed acidosis, five patients (26.7%) with diabetic ketosis died, and one of these (25.0%) presented with acidosis. Two (7.4%) and four (14.3%) of the 27 non‐diabetic ketotic patients developed severe acidosis and died, respectively, and one (25.0%) of these presented with acidosis. This suggests that COVID‐19 infection caused ketosis or ketoacidosis, and induced diabetic ketoacidosis for those with diabetes. Ketosis increased the length of hospital stay and mortality. Meanwhile, diabetes increased the length of hospital stay for patients with ketosis but had no effect on their mortality.

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Section: Discussionmentioning

confidence: 60%

COVID‐19 infection may cause ketosis and ketoacidosis

Xiu-fang

Chen

et al. 2020

Diabetes Obesity Metabolism

461

465

View full text Add to dashboard Cite

show abstract

“…However, the Kussmaul pattern of breathing and tachypnea along with history of diabetes mellitus prompted doctors to check venous blood gas to rule out acidosis. EDKA could result from multiple precipitants, but decreased oral intake is the most cited stressor for precipitating EDKA with or without SGLT2 inhibitor use [ 2 , 3 , 5 , 6 ]. In addition, studies have shown that SGLT2 inhibitors, in general, increase the risk of DKA by sevenfold [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was classically considered a rare incident, but it is likely underreported [ 2 ]. The etiology of EDKA is unknown, but there are many stressors and conditions that can precipitate an episode in either a diabetic or healthy patient [ 5 , 6 ]. Such stressors include fasting, anorexia, gastroparesis, being on a ketogenic diet, and higher alcohol consumption [ 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Euglycemic diabetic ketoacidosis induced by sodium-glucose cotransporter 2 inhibitor in the setting of prolonged fasting: a case report

Alkatheeri

Alseddeeqi

2022

J Med Case Reports

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Background We describe a case report of a patient with type 2 diabetes on sodium-glucose cotransporter 2 inhibitor and metformin therapy fasting for Ramadan (a holy month observed in the Islamic nation) diagnosed with euglycemic diabetic ketoacidosis. Case presentation The patient was a 51-year-old Moroccan male with history of type 2 diabetes mellitus on dapagliflozin and metformin. He presented with abdominal pain, vomiting, loss of appetite, and shortness of breath. He observed Ramadan month by fasting an average of 14 hours daily for 30 days. The patient was admitted with severe metabolic acidosis with a high anion gap and positive ketonuria in the setting of serum glucose of 13.5 mmol/L (243 mg/dL). The patient was rehydrated and started on insulin infusion according to the diabetic ketoacidosis protocol following the diagnosis of euglycemic diabetic ketoacidosis. Conclusion Dapagliflozin is associated with euglycemic diabetic ketoacidosis in the setting of prolonged fasting. Counseling and possible medication adjustment should be added to clinical practice in those planning to decrease caloric intake through dedicated fasting including Ramadan or weight-loss-directed behavioral modifications, especially if taking sodium-glucose cotransporter 2 inhibitors.

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“…Ketoacidosis is a severe metabolic disorder characterized by the accumulation of ketone bodies and acidosis, is mostly seen in people with diabetes, and is rarely induced by other pathological conditions [4]. However, lactation ketoacidosis is a rare cause of HAGMA affecting breastfeeding mothers.…”

Section: Discussionmentioning

confidence: 99%

Lactation Ketoacidosis in a COVID- 19 patient: A Case Report

AlMweisheer

AlAtawi

2021

JMLPH

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Lactation ketoacidosis is an uncommon cause of high anion gap metabolic acidosis affecting breastfeeding women due to increased metabolic demands, reduction in carbohydrate intake, and acute illness. Meanwhile, recent literature showed that COVID-19 might cause ketosis, ketoacidosis, and diabetic ketoacidosis. We report a case of a 22-year-old lady, four weeks postpartum, with a confirmed diagnosis of COVID-19. She presented with severe symptomatic ketoacidosis with a high anion gap, ketonuria and hypoglycemia that was due to lactation ketoacidosis. She was not tolerating orally for days because of abdominal pain, vomiting, and viral infection. After proper treatment in the ward for the presenting symptoms of lactation ketoacidosis and refeeding, she rapidly improved and discharged five days later. While ketoacidosis may be induced by starvation and/or lactation, it is our conclusion that the condition may be aggravated by COVID-19 infection. Emergency services should consider the risk of lactation ketoacidosis exacerbated by COVID- 19 in postpartum women.

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Euglycemic ketoacidosis induced by therapeutic fasting in a non-diabetic patient

Cited by 11 publications

References 13 publications

COVID‐19 infection may cause ketosis and ketoacidosis

COVID‐19 infection may cause ketosis and ketoacidosis

Euglycemic diabetic ketoacidosis induced by sodium-glucose cotransporter 2 inhibitor in the setting of prolonged fasting: a case report

Lactation Ketoacidosis in a COVID- 19 patient: A Case Report

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