Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Curr Diab Rep. 2020 May 19;20(7):25. doi: 10.1007/s11892-020-01307-x.
Diabetic ketoacidosis is a life-threatening complication of diabetes characterized by hyperglycemia, acidosis, and ketosis. Ketoacidosis may occur with blood glucose level < 200 mg/dl (improperly defined as euglycemic ketoacidosis, euKA) and also in people without diabetes. The absence of marked hyperglycemia can delay diagnosis and treatment, resulting in potential serious adverse outcomes.
Recently, with the wide clinical use of sodium glucose co-transporter 2 inhibitors (SGLT2i), euKA has come back into the spotlight. Use of SGLT2i use can predispose to the development of ketoacidosis with relatively low or normal levels of blood glucose. This condition, however, can occur, in the absence of diabetes, in settings such as pregnancy, restriction on caloric intake, glycogen storage diseases or defective gluconeogenesis (alcohol abuse or chronic liver disease), and cocaine abuse. euKA is a challenging diagnosis for most physicians who may be misled by the presence of normal glycemia or mild hyperglycemia. In this article, we review pathophysiology, etiologies, clinical presentation and the management of euKA.
糖尿病酮症酸中毒是一种危及生命的糖尿病并发症，其特征为高血糖、酸中毒和酮症。酮症酸中毒可发生于血糖水平 < 200mg/dl（定义不当，即血糖正常性酮症酸中毒，euKA），也可发生于无糖尿病的人群中。由于缺乏明显的高血糖，可能会延误诊断和治疗，导致潜在的严重不良后果。
最近，随着钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）的广泛临床应用，euKA 再次成为关注焦点。SGLT2i 的使用可能导致血糖水平相对较低或正常时发生酮症酸中毒。然而，在没有糖尿病的情况下，这种情况可能发生于妊娠、热量摄入限制、糖原贮积病或糖异生缺陷（酒精滥用或慢性肝病）以及可卡因滥用等情况下。对于大多数医生来说，euKA 的诊断具有挑战性，他们可能会被正常血糖或轻度高血糖所误导。本文综述了 euKA 的病理生理学、病因、临床表现和治疗。
