Highlights
- •Eu-DKA is a life-threatening emergency and need immediate evaluation and treatment.
- •Eu-DKA is characterized by hyperglycemia with blood glucose levels <200 mg/dl.
- •Eu-DKA can result in delayed diagnosis and treatment.
- •Eu-DKA might occur not so infrequently in individuals treated with SGLT2i.
Abstract
Euglycemic DKA (eu-DKA) is a life-threatening emergency. It may occur in patients
with both type 1 and type 2 DM, and characterized by milder degrees of hyperglycemia
with blood glucose level < 200 mg/dl, which can result in delayed diagnosis and treatment
with potential for adverse metabolic consequences.
Following the wide introduction of the sodium glucose transporter 2 inhibitors (SGLT2i)
in therapeutic practice for DM type 2 treatment the amount of eu-DKA increased and
therefore, interest to this entity rose. Other causes associated with eu-DKA include
pregnancy, decreased caloric intake, heavy alcohol use, insulin use prior to hospital
admission, cocaine abuse, pancreatitis, sepsis, chronic liver disease and liver cirrhosis.
Patients with eu-DKA as well as with DKA need immediate referral for emergency evaluation
and treatment.
The treatment includes rapid correction of dehydration, correction electrolyte abnormalities,
and use of insulin drip until the anion gap, and bicarbonate levels normalize. Increased
glucose administration using higher percentages of dextrose (10 or 20%) are required
to facilitate the concomitant administration of the relatively large amounts of insulin
that are needed to correct the severe acidosis in these patients.
Abbreviations:
DM (diabetes mellitus), DKA (diabetic ketoacidosis), Eu-DKA (euglycemic DKA), Nicotin (amideadenine dinucleotide (NAD)), SGLT2i (sodium glucose transporter 2 inhibitors), CPT-I (palmitoyl-transferase–I), AKA (alcoholic ketoacidosis), LADA (Latent autoimmune diabetes of adult)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 23, 2019
Accepted:
March 19,
2019
Received in revised form:
March 14,
2019
Received:
January 19,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
