Lee Maximus Kyung Hyun, Ball Perry A
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, United States.
Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, United States.
Surg Neurol Int. 2024 Aug 16;15:284. doi: 10.25259/SNI_295_2024. eCollection 2024.
Diabetic ketoacidosis (DKA) is a life-threatening condition among diabetic patients characterized by metabolic anion gap (AG) acidosis of arterial pH <7.30, glucose >250 mg/dL, and positive ketones. The triggers for DKA can be infection, surgery, and, in reported cases, intraparenchymal hemorrhage (IPH). In rare cases of DKA, despite being in active ketoacidosis, glucose levels may be within normal or accepted range. Such a condition is called euglycemic DKA. It has been recently recognized in association with the use of sodium glucose co-transporter-2 (SGLT-2) inhibitors in the treatment of type 2 diabetes.
An 83-year-old male taking an SGLT-2 inhibitor (empagliflozin) for type 2 diabetes presented with an IPH. His laboratory studies revealed an elevated AG acidosis, an elevated beta hydroxybutyrate, and serum glucose levels within the acceptable range. Urine studies revealed elevated ketones and glucose. The diagnosis of euglycemic DKA was made, and the patient was treated with insulin and glucose infusions.
Like hyperglycemic ketoacidosis, euglycemic DKA requires prompt recognition and immediate aggressive medical therapy, but the diagnosis can be challenging, and the treatment using insulin in the setting of a normal glucose can be counterintuitive. Euglycemic DKA can often be missed in the setting of blood glucose not being elevated. Prompt recognition and treatment are critical for successful management.
糖尿病酮症酸中毒（DKA）是糖尿病患者中一种危及生命的病症，其特征为动脉血pH值<7.30的代谢性阴离子间隙（AG）酸中毒、血糖>250mg/dL以及酮体阳性。DKA的诱发因素可以是感染、手术，以及在已报道的病例中，脑实质内出血（IPH）。在罕见的DKA病例中，尽管处于活动性酮症酸中毒状态，但血糖水平可能在正常或可接受范围内。这种情况被称为正常血糖性DKA。最近已认识到它与在2型糖尿病治疗中使用钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂有关。
一名83岁男性，因2型糖尿病正在服用SGLT-2抑制剂（恩格列净），出现了脑实质内出血。他的实验室检查显示AG酸中毒升高、β-羟丁酸升高，且血清葡萄糖水平在可接受范围内。尿液检查显示酮体和葡萄糖升高。诊断为正常血糖性DKA，患者接受了胰岛素和葡萄糖输注治疗。
与高血糖性酮症酸中毒一样，正常血糖性DKA需要及时识别并立即进行积极的药物治疗，但诊断可能具有挑战性，并且在血糖正常的情况下使用胰岛素进行治疗可能有悖常理。在血糖未升高的情况下，正常血糖性DKA常常会被漏诊。及时识别和治疗对于成功管理至关重要。
