Division of Endocrinology, Harbor-UCLA Medical Center, Torrance, California, USA.
Division of Endocrinology, Inova Fairfax Hospital, Falls Church, Virginia, USA.
BMJ Open Diabetes Res Care. 2023 Oct;11(5). doi: 10.1136/bmjdrc-2023-003666.
Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglycemia seen in diabetic ketoacidosis (DKA). The paper presents a classification system for the severity of EDKA, categorizing it into mild, moderate, and severe based on serum pH and bicarbonate levels. Another classification system is proposed to define stages of EDKA based on anion gap and ketones at the time of diagnosis and during the treatment period. A treatment algorithm is proposed to guide clinicians in managing EDKA. This treatment algorithm includes monitoring anion gap and ketones to guide insulin and fluid management, and slower transition to subcutaneous insulin to prevent a relapse. Increased awareness of EDKA is essential for a timely diagnosis because an early diagnosis and treatment can improve clinical outcomes.
血糖正常的糖尿病酮症酸中毒（EDKA）是一种与钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂药物的广泛使用相关的糖尿病新兴并发症。本篇综述强调了 EDKA 的发病率不断上升，以及由于缺乏糖尿病酮症酸中毒（DKA）中常见的高血糖标志，其诊断面临的挑战。本文提出了一种 EDKA 严重程度的分类系统，根据血清 pH 值和碳酸氢盐水平将其分为轻度、中度和重度。还提出了另一种分类系统，根据诊断时和治疗期间的阴离子间隙和酮体来定义 EDKA 的阶段。提出了一种治疗算法来指导临床医生治疗 EDKA。该治疗算法包括监测阴离子间隙和酮体，以指导胰岛素和液体管理，并更缓慢地过渡到皮下胰岛素以防止复发。提高对 EDKA 的认识对于及时诊断至关重要，因为早期诊断和治疗可以改善临床结果。
