Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

Abstract

Euglycaemic ketoacidosis is a rare endocrine emergency, which can have disastrous consequences if left undiagnosed. We present the case of a 57 year old man with type 2 diabetes who developed ketoacidosis (DKA) following a myocardial infarction, despite being normoglycaemic, following discontinuation of his insulin infusion in an intensive care setting. The case highlights the importance of capillary ketone body testing in this scenario as well as the dangers of an over reliance on blood glucose values in the diagnosis of ketoacidosis. The notion that DKA can occur in both type 1 and type 2 diabetes is reaffirmed and the value of adequate insulin therapy in euglycaemic ketoacidosis is emphasized.

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References

  1. Wright J, Ruck K, Rabbitts R, et al. Diabetic ketoacidosis (DKA) in Birmingham, UK 2000-2009: an evaluation of risk factors for recurrence and mortality. Br J Diabetes Vasc Dis 2009; 9: 278–82.
  2. Jenkins D, Close CF, Krents AJ, et al. Euglycaemic diabetic ketoacidosis: does it exist? Acta Diabetol 1993; 30: 251–3.
  3. Munro JF, Campbell IW, McCuish AC, et al. Euglycaemic ketoacidosis BMJ 1973; 2: 578–80.
  4. Newton CA, Raskin P. Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences. Arch Intern Med 2004; 164(17): 1925–31.
  5. Tarif N, Badir W. Euglycaemic Diabetic Ketoacidosis in Pregnancy. Saudi J Kidney Dis Transpl 2007; 18(4):590–3.
  6. Burge MR, Hardy KJ, Schade DS. Short term fasting is a mechanism for the development of euglycaemic ketoacidosis during periods of insulin deficiency. J Clin Endo Metab 1993; 76: 1192–8.
  7. Bellomo R, Colman P, Caudwell J, et al. Acute haemofiltration with dialysis: effect on insulin concentrations and glycemic control in critically ill patients. Crit Care Med 1992; 20(12): 1672–6.
  8. Savage MW, Dhatariya KK, Kilvert A, et al. Joint Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011; 28(5): 508–15.

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Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

14th March 2016
PMID: 23364105
Authors Affiliations
Robert John MBBS FRCA ST6 Anaesthetics Hammersmith Hospital, Du Cane Road, London W12 0HS
Hemang Yadav MA, MBBS Internal Medicine Resident, Mayo Clinic 201st St Rochester, MN 55905, USA
Martin John MBBS FRCA ST5 Anaesthetics St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH

Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

Cite this article as:

John R, Yadav H, John M. Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit. Acute Med. 2012;11(4):219-21. PMID: 23364105.

Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

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