Joseph Franklin, Anderson Lydia, Goenka Niru, Vora Jiten
Diabetes Centre, Countess of Chester NHS Foundation Trust, Chester, UK.
J Gen Intern Med. 2009 Jan;24(1):129-31. doi: 10.1007/s11606-008-0829-0. Epub 2008 Oct 31.
True euglycemic diabetic ketoacidosis [blood glucose <200 mg/dl (11.1 mmol/l)] is relatively uncommon and in type 1 diabetes can be caused by starvation of any cause in conjunction with an intercurrent illness. We report a case of euglycemic diabetic ketoacidosis precipitated by starvation resulting from severe depression in a patient with type 1 diabetes. He was acidotic with ketonuria, but his blood glucose was only 105 mg/dl (5.8 mmol/l). He was rehydrated, the acidosis was corrected, and his depression was later treated. This case involves the complex interplay among type 1 diabetes, depression, ketoacidosis, and starvation physiology resulting in glucose concentrations in keeping with euglycemic diabetic ketoacidosis. The case also highlights that even in the absence of hyperglycemia, acid/base status should be assessed in an ill patient with diabetes, and in cases of euglycemic diabetic ketoacidosis, the diagnosis of depression should be considered as a cause for suppressed appetite and anorexia.
真性正常血糖性糖尿病酮症酸中毒（血糖<200mg/dl[11.1mmol/l]）相对少见，在1型糖尿病中，可由任何原因导致的饥饿并伴有并发疾病引起。我们报告一例1型糖尿病患者因严重抑郁症导致饥饿而引发的正常血糖性糖尿病酮症酸中毒病例。他存在酸中毒并伴有酮尿，但血糖仅为105mg/dl（5.8mmol/l）。给予他补液治疗，纠正了酸中毒，随后对其抑郁症进行了治疗。该病例涉及1型糖尿病、抑郁症、酮症酸中毒和饥饿生理学之间的复杂相互作用，导致血糖浓度符合正常血糖性糖尿病酮症酸中毒。该病例还强调，即使在无高血糖的情况下，对于患病的糖尿病患者也应评估酸碱状态，而在正常血糖性糖尿病酮症酸中毒病例中，应考虑抑郁症是导致食欲减退和厌食的原因。
