Euglycemic diabetic ketoacidosis: etiologies, evaluation, and management
Open accessAbstract
Introduction Diabetic ketoacidosis is an endocrine emergency. A subset of diabetic patients may present with relative euglycemia with acidosis, known as euglycemic diabetic ketoacidosis (EDKA), which is often misdiagnosed due to a serum glucose Objective This narrative review evaluates the pathogenesis, diagnosis, and management of EDKA for emergency clinicians. Discussion EDKA is comprised of serum glucose Conclusions Clinician knowledge of this condition can improve the evaluation and management of patients with EDKA.
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Euglycemic DKA develops in the presence of low insulin levels and can be associated with a variety of factors including reduced food intake, pregnancy, alcohol use, liver failure, and/or SGLT2 inhibitor therapy.
“Euglycemic DKA develops in the presence of low insulin levels and can be associated with a variety of factors including reduced food intake, pregnancy, alcohol use, liver failure, and/or SGLT2 inhibitor therapy (167).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [167]
Cites
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6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s006 · Cited by 440 · see citing works
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Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., et al. (2024) · Diabetes Care · doi:10.2337/dci24-0032 · Cited by 278 · see citing works
16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s016 · Cited by 80 · see citing works
- Authors
- Long, B., Lentz, S., Koyfman, A., & Gottlieb, M.
- Affiliations
- Brooke Army Medical Center (US)
- University of Vermont (US)
- The University of Texas Southwestern Medical Center (US)
- Rush University Medical Center (US)
- Corresponding author
- Long, Brit
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 44
- Pages
- 157-160
- ISSN
- 0735-6757 (ISSN-L)
- OpenAlex
- W3133373172
- Cited by
- 150
- References
- 5
- Citations by year
- 2026: 25 · 2025: 31 · 2024: 52 · 2023: 26 · 2022: 11 · 2021: 5
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The American Journal of Emergency Medicine (acceptedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Keywords
- euglycemic diabetic ketoacidosis, diabetic ketoacidosis, anion gap metabolic acidosis, ketosis, SGLT2 inhibitors, insulin deficiency, insulin resistance, glucagon, ketone bodies, starvation, chronic liver disease, pregnancy, infection, alcohol consumption, hypoglycemia, fluid resuscitation, insulin therapy, endocrine emergencies
- MeSH terms
- Diagnosis, Differential, Emergency Service, Hospital, Humans, Diabetic Ketoacidosis
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