Euglycemic diabetic ketoacidosis:A missed diagnosis  

作　　者：Prashant Nasa Sandeep Chaudhary Pavan Kumar Shrivastava Aanchal Singh 

机构地区：[1]Department of Critical Care Medicine,NMC Specialty Hospital,Dubai 7832,United Arab Emirates [2]Department of Endocrinology,NMC Specialty Hospital,Dubai 7832,United Arab Emirates [3]Department of Internal Medicine,NMC Specialty Hospital,Dubai 7832,United Arab Emirates

出　　处：《World Journal of Diabetes》2021年第5期514-523,共10页世界糖尿病杂志（英文版）（电子版）

摘　　要：Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units;it may delay diagnosis and treatment causing worse outcomes.Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus.With the addition of sodium/glucose cotransporter-2 inhibitors in diabetes mellitus management,euglycemic DKA incidence has increased.The other causes of euglycemic DKA include pregnancy,fasting,bariatric surgery,gastroparesis,insulin pump failure,cocaine intoxication,chronic liver disease and glycogen storage disease.The pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit,milder degree of insulin deficiency or resistance and increased glucagon/insulin ratio.Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones.The diagnostic workup includes arterial blood gas for metabolic acidosis,serum ketones and exclusion of other causes of high anion gap metabolic acidosis.Euglycemic DKA treatment is on the same principles as for DKA with correction of dehydration,electrolytes deficit and insulin replacement.The dextrosecontaining fluids should accompany intravenous insulin to correct metabolic acidosis,ketonemia and to avoid hypoglycemia.

关 键 词：Diabetic Ketoacidosis Sodium/glucose co-transporter-2 inhibitors Pregnancy with diabetic ketoacidosis Diabetes complications Pregnancy in diabetes KETOSIS Metabolic acidosis 

分 类 号：R587.2[医药卫生—内分泌]