Diabetic Ketoacidosis in an Euglycemic Patient

Diabetes is a common disease, and the number of patients is increasing every year. We report a case of a 34-year-old man with a history of diabetes mellitus (diagnosed at eight years old) and was on treatment with tablet glimepride with poor compliance. The patient sought consultation due to vomiting and abdominal pain 12 hours after onset along with burning micturition for four days. His initial blood sugar random (BSR) level was 84 mg/dL. Further lab tests revealed pH: 7.14, bicarbonate: 6.4 mEq/dL, sodium: 141, potasium: 3.8, chloride: 107, PO2: 115, PCO2: 19.4, serum amylase: 51, base excess (BE): -21.3 mmol/L, and positive ketonemia, i.e. 1.39. He was reanimated with parenteral crystalloids and insulin infusion. Eventually with subsequent arterial blood gases (ABGs) and ketones, the patient got better and was eventually declared to be out of diabetic ketoacidosis (DKA) and later discharged. There are very less studies done on euglycemic DKA (eu-DKA); so many physicians fail to diagnose the patients properly and they fall into the invisible cases chunk.