Dagdeviren Murat, Akkan Tolga, Ertugrul Derun Taner
Department of Endocrinology and Metabolism, Ankara Etlik City Hospital, Ankara, Türkiye.
Department of Endocrinology and Metabolism, Eskisehir City Hospital, Eskisehir, Türkiye.
Turk J Emerg Med. 2024 Jan 8;24(1):1-7. doi: 10.4103/tjem.tjem_110_23. eCollection 2024 Jan-Mar.
Diabetic ketoacidosis (DKA) is the most common emergency complication of diabetes. Euglycemic DKA (EDKA), on the other hand, has been known for many years but is a rare and under-recognized condition and constitutes a very small proportion of DKA cases. However, in recent years, an increase in the incidence of EDKA has been observed with the widespread use of sodium-glucose co-transporter 2 inhibitors, which have proven benefits in the treatment of diabetes mellitus and its cardiorenal complications, heart failure, and chronic kidney disease. Unlike classical DKA, these patients without significant hyperglycemia can easily be missed in emergency departments. EDKA should be kept in mind in patients with diabetes presenting with DKA but with a blood glucose level <250 mg/dL. The diagnostic and therapeutic approach after clinical suspicion in these patients is similar to classical DKA and is briefly summarized in this review. The most important point in treatment is that these patients are normoglycemic but have a significant insulin deficiency (relative or absolute). Therefore, insulin is the mainstay of the treatment and should be given together with dextrose solutions to avoid hypoglycemia.
糖尿病酮症酸中毒（DKA）是糖尿病最常见的急性并发症。另一方面，正常血糖性DKA（EDKA）虽已被认识多年，但却是一种罕见且未得到充分认识的病症，在DKA病例中占比极小。然而，近年来，随着钠-葡萄糖协同转运蛋白2抑制剂的广泛使用，EDKA的发病率有所上升，这些抑制剂在治疗糖尿病及其心肾并发症、心力衰竭和慢性肾脏病方面已被证明具有益处。与经典DKA不同，这些血糖无显著升高的患者在急诊科很容易被漏诊。对于表现为DKA但血糖水平<250 mg/dL的糖尿病患者，应考虑到EDKA。对这些患者临床怀疑后的诊断和治疗方法与经典DKA相似，本综述将简要总结。治疗中最重要的一点是，这些患者血糖正常，但存在明显的胰岛素缺乏（相对或绝对）。因此，胰岛素是治疗的主要手段，应与葡萄糖溶液一起给予以避免低血糖。
