Rawla Prashanth, Vellipuram Anantha R, Bandaru Sathyajit S, Pradeep Raj Jeffrey
Department of Internal Medicine, Memorial Hospital of Martinsville and Henry County, Martinsville, Virginia, USA.
Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Endocrinol Diabetes Metab Case Rep. 2017 Sep 4;2017. doi: 10.1530/EDM-17-0081. eCollection 2017.
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.
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.
正常血糖性糖尿病酮症酸中毒（EDKA）是一种临床三联征，包括阴离子间隙增加的代谢性酸中毒、酮血症或酮尿症以及血糖水平正常（<200mg/dL）。这种情况是一个诊断挑战，因为正常血糖掩盖了潜在的糖尿病酮症酸中毒。因此，需要高度的临床怀疑，并排除其他诊断。在此，我们介绍两名接受常规胰岛素治疗的患者，他们因EDKA诊断入院。第一名患者胰岛素泵出现故障，第二名患者患有尿路感染和恶心，从而导致饥饿。他们两人均按照血糖水平的治疗方案接受了积极的静脉补液和胰岛素滴注治疗，直至阴离子间隙恢复正常，代谢性酸中毒得到纠正。本病例系列简要总结了EDKA的病因、病理生理学和治疗方法。
正常血糖性糖尿病酮症酸中毒较为罕见。即使糖尿病酮症酸中毒（DKA）患者的血糖水平正常，也应考虑酮症。诊断EDKA需要高度的临床怀疑，因为正常血糖水平会掩盖潜在的DKA并导致诊断和治疗困境。无论血糖水平如何，糖尿病患者出现不适时都应检查血pH值以及血或尿酮体。
