The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index.
Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma
Open accessAbstract
Summary: Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus, a high clinical suspicion is warranted, and other diagnosis ruled out. Here, we present two patients on regular insulin treatment who were admitted with a diagnosis of EDKA. The first patient had insulin pump failure and the second patient had urinary tract infection and nausea, thereby resulting in starvation. Both of them were aggressively treated with intravenous fluids and insulin drip as per the protocol for the blood glucose levels till the anion gap normalized, and the metabolic acidosis reversed. This case series summarizes, in brief, the etiology, pathophysiology and treatment of EDKA. Learning points: Euglycemic diabetic ketoacidosis is rare. Consider ketosis in patients with DKA even if their serum glucose levels are normal. High clinical suspicion is required to diagnose EDKA as normal blood sugar levels masquerade the underlying DKA and cause a diagnostic and therapeutic dilemma. Blood pH and blood or urine ketones should be checked in ill patients with diabetes regardless of blood glucose levels.
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“There is a potential risk of severe hypoglycemia if persons with DM do not appropriately reduce the prandial insulin dosage.1171–1174”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1173]
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“Tachyphylaxis is often seen after several years of therapy.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1173]
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“Nausea is a common adverse effect.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1173]
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Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication
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Cited by
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Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507
Euglycemic diabetic ketoacidosis: A missed diagnosis
Nasa, P., CHAUDHARY, S. K., Shrivastava, P. K., & Singh, A. (2021) · World Journal of Diabetes · doi:10.4239/wjd.v12.i5.514 · Cited by 180
Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors
Chow, E., Clement, S. C., & Garg, R. (2023) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2023-003666 · Cited by 183
Euglycemic diabetic ketoacidosis: etiologies, evaluation, and management
Long, B., Lentz, S., Koyfman, A., & Gottlieb, M. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.02.015 · Cited by 150
Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis
Yu, X., Zhang, S., & Zhang, L. (2018) · International Journal of Endocrinology · doi:10.1155/2018/7074868 · Cited by 102
Metadata
- Authors
- Rawla, P., Vellipuram, A. R., Bandaru, S. S., & Pradeep Raj, J.
- Affiliations
- Sovah Health Martinsville (US)
- Texas Tech University (US)
- Beth Israel Deaconess Medical Center (US)
- 4Department of Pharmacology, St John’s Medical College, Bangalore, India
- Corresponding author
- Rawla, Prashanth
- Venue
- Endocrinology, Diabetes & Metabolism Case Reports
- Publisher
- Bioscientifica
- Published
- 2017-09-04
- Volume
- 2017
- ISSN
- 2052-0573 (ISSN-L)
- PMC
- PMC5592704
- OpenAlex
- W2752336798
- Cited by
- 139
- References
- 14
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 27 · 2023: 14 · 2022: 29 · 2021: 17 · 2020: 15 · 2019: 11 · 2018: 6 · 2017: 4
- FWCI
- 7.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Endocrinology Diabetes and Metabolism Case Reports (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- euglycemic diabetic ketoacidosis, diabetic ketoacidosis, anion gap metabolic acidosis, ketonuria, ketonemia, normoglycemia, starvation, urinary tract infection, intravenous insulin therapy, fluid resuscitation, diabetes mellitus
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