Euglycemic Diabetic Ketoacidosis

General 

Serum ketones + metabolic acidosis without the typical elevated blood sugars we see in Diabetic Ketoacidosis (DKA)

Risk factors 

• SGLT-2 inhibitors – medication that end in “–gliflozin” 
• Dehydration or decreased PO or ETOH abuse 
• Concurrent illness

Pathophysiology

SGLT-2 inhibitors prevent glucose reabsorption from proximal renal tubules

-->glucosuria suppresses insulin release

-->relative insulin deficiency leads to lipolysis, free fatty acid oxidation

-->ketones produced

Clinical 

• Suspect euDKA in any T1DM or T2DM who presents with epigastric pain, nausea, vomiting, shortness of breath or found to have a metabolic acidosis 
• These patients should get a serum ketones drawn
• Difficult to distinguish from alcoholic ketoacidosis --> check med list

Management 

• Same as typical DKA management but start D5 earlier because starting with glucose of 200 to 300.
• Consider discontinuing SGLT-2 inhibitor ideally in conjunction with PCP

References

https://www.uptodate.com/contents/sodium-glucose- co-transporter- 2- inhibitors-for- the-treatment- of-type- 2-diabetes-

http://empharmd.blogspot.com/2016/05/euglycemic-dka- from-sglt2- inhibitors.html