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Developing a Protocol for Management of Euglycemic Diabetic Ketoacidosis
Zulma Cardona1, Jared G Friedman1, Nevin Kamal1
1Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 530, Chicago, IL, 60611, USA.
Current Diabetes Reports
|September 3, 2025
Summary
Euglycemic diabetic ketoacidosis (euDKA), often linked to SGLT2 inhibitors, requires specialized treatment. A new protocol using fixed insulin and dextrose titration improves euDKA management, addressing limitations of traditional DKA protocols.
Area of Science:
- Endocrinology
- Pharmacology
- Internal Medicine
Background:
- Euglycemic diabetic ketoacidosis (euDKA) incidence is rising with sodium-glucose cotransporter 2 inhibitor (SGLT2i) use.
- Traditional diabetic ketoacidosis (DKA) protocols are ineffective for euDKA due to normal glucose levels.
- Existing guidelines do not specifically address euDKA management.
Purpose of the Study:
- Review current data on euDKA.
- Introduce a novel management protocol for euDKA.
- Address the challenges in treating euDKA with SGLT2i medications.
Main Methods:
- Literature review of euDKA cases and outcomes.
- Development and implementation of a standardized euDKA treatment protocol in an intensive care unit.
- Protocol involves fixed insulin infusion and dextrose-containing fluid titration.
Main Results:
- euDKA patients experience longer hospital stays and slower anion gap closure compared to hyperglycemic DKA.
- Increased SGLT2i prescribing correlates with a higher risk of euDKA.
- The new protocol has been approved and is currently in use.
Conclusions:
- A standardized protocol for euDKA is necessary due to treatment challenges.
- The developed protocol offers a targeted approach for euDKA management.
- Further research is needed to assess the protocol's safety and efficacy across different settings.
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