Tauseef Abubakar, Asghar Muhammad Sohaib, Zafar Maryam, Lateef Noman, Thirumalareddy Joseph
Internal Medicine, Creighton University, Omaha, USA.
Internal Medicine, Dow International Medical College, Dow University Hospital, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2020 Aug 27;12(8):e10078. doi: 10.7759/cureus.10078.
We present a case of a male diabetic patient with one of the most well-known major complications of diabetes mellitus (DM), i.e., diabetic ketoacidosis (DKA). The finding of euglycemic DKA, or DKA with blood glucose levels of less than 200 mg/dL, is a rare occurrence especially in patients with type II DM. He presented with hypotension and increased anion gap metabolic acidosis on a background of keto diet for weight loss and recent use of sodium-glucose linked transporter inhibitors. He was successfully managed with dextrose water, insulin infusion, and potassium replacement. A ketogenic diet consists of high fat, low carbohydrate, and adequate protein regimen that sends the body into a state of starvation in which high glucagon and low insulin levels lead to the activation of other counter-regulatory hormones, such as epinephrine and cortisol, that causes a rise in the level of free fatty acids in the blood increasing ketone body production. Rarely, sodium-glucose linked transport inhibitors can also cause DKA, with euglycemia instead of hyperglycemia. The finding of plasma glucose levels within normal range prompted patients to maintain and sometimes even lower their insulin dose; even their providers were often misled by the euglycemia that resulted in delayed diagnosis and treatment. Thus, it is imperative to stay aware of the possible clinical presentations in order to intervene in a timely manner and prevent further progression and complications.
我们报告一例男性糖尿病患者，其患有糖尿病（DM）最广为人知的主要并发症之一，即糖尿病酮症酸中毒（DKA）。血糖正常的DKA，即血糖水平低于200mg/dL的DKA，这种情况很罕见，尤其是在II型糖尿病患者中。他在进行生酮饮食以减肥且近期使用钠-葡萄糖协同转运蛋白抑制剂的背景下，出现了低血压和阴离子间隙代谢性酸中毒增加的症状。通过给予葡萄糖水、胰岛素输注和补钾，他得到了成功治疗。生酮饮食是一种高脂肪、低碳水化合物和适量蛋白质的饮食方案，会使身体进入饥饿状态，其中高胰高血糖素和低胰岛素水平会导致其他反调节激素（如肾上腺素和皮质醇）的激活，进而导致血液中游离脂肪酸水平升高，增加酮体生成。很少见的是，钠-葡萄糖协同转运蛋白抑制剂也可导致DKA，且血糖正常而非血糖过高。血浆葡萄糖水平在正常范围内这一发现促使患者维持甚至有时降低胰岛素剂量；甚至他们的医疗服务提供者也常常被血糖正常所误导，从而导致诊断和治疗延迟。因此，必须了解可能的临床表现，以便及时进行干预，防止病情进一步发展和出现并发症。
