Long Brit, Lentz Skyler, Koyfman Alex, Gottlieb Michael
Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States of America.
Division of Emergency Medicine, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, United States of America.
Am J Emerg Med. 2021 Jun;44:157-160. doi: 10.1016/j.ajem.2021.02.015. Epub 2021 Feb 16.
Diabetic ketoacidosis is an endocrine emergency. A subset of diabetic patients may present with relative euglycemia with acidosis, known as euglycemic diabetic ketoacidosis (EDKA), which is often misdiagnosed due to a serum glucose <250 mg/dL.
This narrative review evaluates the pathogenesis, diagnosis, and management of EDKA for emergency clinicians.
EDKA is comprised of serum glucose <250 mg/dL with an anion gap metabolic acidosis and ketosis. It most commonly occurs in patients with a history of low glucose states such as starvation, chronic liver disease, pregnancy, infection, and alcohol use. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, which result in increased urinary glucose excretion, are also associated with EDKA. The underlying pathophysiology involves insulin deficiency or resistance with glucagon release, poor glucose availability, ketone body production, and urinary glucose excretion. Patients typically present with nausea, vomiting, malaise, or fatigue. The physician must determine and treat the underlying etiology of EDKA. Laboratory assessment includes venous blood gas for serum pH, bicarbonate, and ketones. Management includes resuscitation with intravenous fluids, insulin, and glucose, with treatment of the underlying etiology.
Clinician knowledge of this condition can improve the evaluation and management of patients with EDKA.
糖尿病酮症酸中毒是一种内分泌急症。一部分糖尿病患者可能表现为伴有酸中毒的相对正常血糖，即正常血糖性糖尿病酮症酸中毒（EDKA），由于血清葡萄糖<250mg/dL，这种情况常被误诊。
本叙述性综述为急诊临床医生评估EDKA的发病机制、诊断和管理。
EDKA表现为血清葡萄糖<250mg/dL，伴有阴离子间隙代谢性酸中毒和酮症。它最常见于有低血糖状态病史的患者，如饥饿、慢性肝病、妊娠、感染和酗酒。导致尿葡萄糖排泄增加的钠-葡萄糖协同转运蛋白-2（SGLT2）抑制剂也与EDKA有关。潜在的病理生理学涉及胰岛素缺乏或抵抗伴胰高血糖素释放、葡萄糖供应不足、酮体生成和尿葡萄糖排泄。患者通常表现为恶心、呕吐、不适或疲劳。医生必须确定并治疗EDKA的潜在病因。实验室评估包括检测血清pH值、碳酸氢盐和酮体的静脉血气分析。管理措施包括用静脉输液、胰岛素和葡萄糖进行复苏，并治疗潜在病因。
临床医生对这种情况的了解可以改善EDKA患者的评估和管理。
