Euglycaemic Diabetic Ketoacidosis

Last Updated on February 4, 2023

Introduction

• Occurs in 10% of DKA, where blood glucose level is normal
• Starvation -> ketosis with normoglycaemia

Definition

• Plasma glucose <11 mmol/L
• Metabolic acidosis (pH <7.30, HCO3 <15 mmol/L)
• Ketonaemia (serum ketone >3 mmol/L)

Risk Factors

• Pregnancy
• SGLT2 inhibitor
• Recent surgery
• Infection
• Poor oral intake / Prolonged fasting
• Omission / Reduction of insulin dose
• Alcohol consumption

Management

• Follow DKA protocol

Others

• Withhold SGLT2-inhibitor until ketoacidosis resolves and patient is tolerating oral intake
• Fluid of choice:
  • Dehydration: NSD5% or D5%
  • Normohydration: D10%

Pitfalls

• High index of suspicion for those who have risk factors euglycaemic DKA has normal dxt

Related Posts

1. Diabetic ketoacidosis

References

1. CPG Management of Type 2 Diabetes Mellitus, 6th Ed
2. Eugycemic diabetic ketoacidosis, NCBI