Advanced Practice: Euglycemic DKA!

Euglycemic Diabetic Ketoacidosis



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



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



  • 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



  • 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 co-transporter- 2- inhibitors-for- the-treatment- of-type- 2-diabetes- from-sglt2- inhibitors.html