What Is Euglycemic Diabetic Ketoacidosis
What Is Euglycemic Diabetic Ketoacidosis Euglycemic diabetic ketoacidosis (euDKA) is a rare but serious complication of diabetes that can be challenging to diagnose because it presents differently from the typical diabetic ketoacidosis (DKA). Unlike classic DKA, which is characterized by high blood glucose levels, euDKA occurs with relatively normal or only mildly elevated glucose levels, making it a potentially deceptive medical emergency. Understanding the nuances of euDKA is essential for both healthcare providers and individuals living with diabetes to ensure prompt diagnosis and treatment.
Diabetic ketoacidosis usually happens when there is a significant deficiency of insulin, leading to high blood sugar, dehydration, and the production of ketones—byproducts of fat metabolism that cause the blood to become acidic. Classic symptoms include extreme thirst, frequent urination, nausea, abdominal pain, rapid breathing, and confusion. In contrast, euDKA presents with similar metabolic disturbances but without the pronounced hyperglycemia typically seen in DKA. What Is Euglycemic Diabetic Ketoacidosis
What Is Euglycemic Diabetic Ketoacidosis The term “euglycemic” refers to normal blood glucose levels, usually defined as less than 200 mg/dL. This phenomenon can occur in various contexts, such as during the use of certain medications like sodium-glucose cotransporter-2 (SGLT2) inhibitors. These drugs lower blood sugar by promoting glucose excretion through the urine, which can mask hyperglycemia even when the body is experiencing significant ketosis and acidosis. As a result, patients on SGLT2 inhibitors may develop euDKA with only mild hyperglycemia or even normal glucose levels.
Other factors contributing to euDKA include prolonged fasting, excessive alcohol consumption, pregnancy, and certain illnesses or infections that increase stress hormones, leading to insulin deficiency. Additionally, reduced
carbohydrate intake—common in low-carb or ketogenic diets—can predispose individuals to ketosis, which, under certain stressors, can escalate into euDKA if insulin levels are insufficient.
What Is Euglycemic Diabetic Ketoacidosis Diagnosis of euDKA hinges on laboratory findings: elevated blood ketones, metabolic acidosis (low blood pH and bicarbonate), and the absence of marked hyperglycemia. Blood tests revealing high anion gap metabolic acidosis alongside positive serum or urine ketones confirm the diagnosis. Because blood glucose may not be significantly elevated, clinicians must maintain a high index of suspicion, especially in patients presenting with nonspecific symptoms like nausea, vomiting, or abdominal pain.
What Is Euglycemic Diabetic Ketoacidosis Treatment for euDKA mirrors that of classic DKA, focusing on correcting dehydration with intravenous fluids, administering insulin to suppress ketogenesis, and replenishing electrolytes such as potassium. Recognizing euDKA early is critical because delayed treatment can lead to severe complications, including cerebral edema, arrhythmias, or even death. Education about the potential for euDKA, especially among patients taking SGLT2 inhibitors, is vital for prevention. Patients should be advised to monitor for symptoms of ketosis and to seek medical attention promptly if they experience unexplained nausea or abdominal pain, especially during illness or fasting.
What Is Euglycemic Diabetic Ketoacidosis In summary, euDKA is a distinctive form of diabetic ketoacidosis characterized by normal or mildly elevated blood glucose levels. Its recognition requires awareness of its unique presentation, especially in the context of modern diabetes management. Prompt diagnosis and treatment are essential to prevent serious outcomes and ensure patient safety.
