Euglycemic diabetic ketoacidosis: Etiologies, evaluation, and management

Area of Science:

• Endocrinology
• Emergency Medicine
• Metabolic Disorders

Background:

• Diabetic ketoacidosis (DKA) is a serious endocrine emergency.
• Euglycemic DKA (EDKA) is a variant characterized by normal serum glucose levels (<250 mg/dL) alongside acidosis and ketosis.
• EDKA is frequently misdiagnosed due to its atypical presentation.

Purpose of the Study:

• To review the pathogenesis, diagnosis, and management of EDKA.
• To enhance emergency clinicians' understanding of EDKA.
• To improve patient evaluation and treatment outcomes for EDKA.

Main Methods:

• Narrative review of existing literature on EDKA.
• Evaluation of EDKA's pathophysiology, clinical presentation, and diagnostic criteria.
• Discussion of management strategies, including fluid resuscitation, insulin, glucose, and treatment of underlying causes.

Main Results:

• EDKA is associated with conditions causing low glucose states (starvation, liver disease, pregnancy, infection, alcohol use) and SGLT2 inhibitors.
• Pathophysiology involves insulin deficiency/resistance, glucagon excess, and ketone production.
• Common symptoms include nausea, vomiting, malaise, and fatigue.

Conclusions:

• EDKA requires prompt diagnosis and management of its underlying etiology.
• Improved clinician awareness of EDKA is essential for effective patient care.
• Timely intervention can prevent severe complications associated with EDKA.