The mainstay of treatment involves rapid correction of dehydration using intravenous fluids The second most important step in the management is the use of insulin drip along with a dextrose containing solution until the anion gap, and bicarbonate levels normalize Periodic checking of urine for ketones and arterial blood gas analysis to estimate anion gap are warranted till the values normalize Here, we presented two patients diagnosed with euglycemic diabetic ketoacidosis both of whom were on regular insulin therapy.
Early detection and management are warranted as this condition may else prove fatal. It is best advised that the clinicians are aware of the possible etiological triggers of EDKA in susceptible patients and actively rule out other differentials thereby minimizing the time required for diagnosing EDKA. If diagnosed early and management aggressively with fluids and insulin drip, EDKA may be easily reversed, thus minimizing morbidity and mortality. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Written informed consent has been obtained from the patients for publication of this article. National Center for Biotechnology Information , U. Endocrinol Diabetes Metab Case Rep. Published online Sep 4. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Correspondence should be addressed to G Sloan; Email: ten. Received Jul 18; Accepted Aug 4. This article has been cited by other articles in PMC. Learning points: Euglycemic diabetic ketoacidosis is rare. Consider ketosis in patients with DKA even if their serum glucose levels are normal.
Background Diabetic ketoacidosis DKA is defined as a clinical triad comprising metabolic acidosis, hyperglycemia and increased ketone bodies in the blood and urine. Case presentation 1 A year-old female with T1DM diagnosed five years back and on an insulin pump for the last two years was admitted with complaints of weakness and inability to eat for the past one day. Table 1 Laboratory investigations of patient 1.
Open in a separate window. Treatment She was treated with 4L bolus of IV normal saline and an insulin drip as per the protocol based on her glucose levels. Outcome and follow-up Patient was discharged to home on long-acting and short-acting insulin and was advised to get her insulin pump fixed on her next appointment with her endocrinologist. Case presentation 2 year-old female diagnosed with T1DM 10 years back, on regular treatment with insulin glargine at bedtime and insulin aspart at sliding scale as needed before meals, came with complaints of burning while urinating and high-grade intermittent fever of up to F associated with chills and rigors.
Investigation A working diagnosis of urinary tract infection was made, and a routine blood work-up was done, the results of which are given in Table 2. Table 2 Laboratory investigations of patient 2. Treatment She was treated with 5L of bolus IV normal saline to reverse the dehydration and was started on insulin drip according to the protocol for her blood glucose levels. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references DKA ketoacidosis and ketones.
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Feddersen E, Lockwood DH. Diabetes Educ. Brink SJ. Diabetic ketoacidosis Acta Paediatr Suppl. Diabetic ketoacidosis: prevention, treatment and complications in children and adolescents. Freeland BS. Diabetic ketoacidosis. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Hyperosmolar Hyperglycemic State. May 1, Issue. Diabetic Ketoacidosis. Merck Manual Professional Version.
Hirsch IB, et al. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment. Ferri FF. Diabetic ketoacidosis. In: Ferri's Clinical Advisor Elsevier;
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