Mukaddam Sajid Hasanali, Tooblani Hasan Mohammed, Gupta Riya
ICU, Ibn Al-Nafees Hospital, Manama, Bahrain.
Kasturba Medical College Mangalore, Mangalore, Karnataka, India
BMJ Case Rep. 2025 Jan 7;18(1):e260473. doi: 10.1136/bcr-2024-260473.
Euglyceamic diabetic ketoacidosis (EuDKA) is an uncommon but serious diabetes mellitus complication associated with risk factors such as fasting, surgery, pregnancy and, more recently, the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i). This case is of a woman with type 2 diabetes and hypertension in her 50s who underwent an incarcerated umbilical hernia repair and abdominoplasty. Two days after discharge, she was readmitted with nausea, vomiting, loss of appetite, low-grade fever and breathing difficulty. Preoperatively, her diabetes management included an SGLT2i. She was diagnosed with EuDKA with high anion gap metabolic acidosis, a medical emergency similar to diabetic ketoacidosis. The normal blood glucose levels in EuDKA can mask the condition, which poses a conundrum for physicians in the emergency department/intensive care units as it may delay diagnosis and treatment, worsening the outcomes. To mitigate this risk, SGLT2i should be stopped 3-4 days before planned surgery with appropriate adjustments to the insulin regimen.
正常血糖性糖尿病酮症酸中毒（EuDKA）是一种不常见但严重的糖尿病并发症，与禁食、手术、妊娠等风险因素相关，最近还与使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）有关。该病例为一名50多岁的2型糖尿病和高血压女性，她接受了嵌顿性脐疝修补术和腹壁成形术。出院两天后，她因恶心、呕吐、食欲不振、低热和呼吸困难再次入院。术前，她的糖尿病治疗方案包括使用SGLT2i。她被诊断为伴有高阴离子间隙代谢性酸中毒的EuDKA，这是一种类似于糖尿病酮症酸中毒的医疗急症。EuDKA患者正常的血糖水平可能会掩盖病情，这给急诊科/重症监护病房的医生带来了难题，因为这可能会延迟诊断和治疗，使病情恶化。为降低这种风险，应在计划手术前3-4天停用SGLT2i，并对胰岛素治疗方案进行适当调整。
