Yomogida Daichi, Hasegawa Suguru, Mizuta Shiori, Horikawa Shinjiro, Koshida Yosinao
Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Toyama, JPN.
Cureus. 2025 May 11;17(5):e83920. doi: 10.7759/cureus.83920. eCollection 2025 May.
Diabetic ketoacidosis (DKA) typically presents with hyperglycemia, but euglycemic diabetic ketoacidosis (EDKA) occurs when patients present with acidosis and normal blood glucose levels. This condition has garnered attention due to its association with sodium-glucose cotransporter-2 (SGLT2) inhibitors and other factors such as sepsis. Acute kidney injury (AKI) often complicates sepsis cases and is associated with metabolic acidosis. Distinguishing between AKI and EDKA can be difficult, particularly when both conditions co-occur, as observed in three ICU cases of sepsis with AKI and EDKA. In this report, the clinical challenges of diagnosing EDKA in critically ill patients, especially in the presence of metabolic acidosis and an elevated anion gap, are highlighted. In these cases, metabolic acidosis was initially attributed to AKI; however, blood ketone levels were essential for confirming EDKA. Treatment for EDKA was prioritized over kidney replacement therapy (KRT), which was only initiated when needed for AKI management. Despite its potential benefits in managing AKI, KRT's role in EDKA treatment requires further investigation. This report emphasizes the importance of early diagnosis of EDKA in diabetic patients with sepsis and AKI, stressing the need for prompt ketone testing and insulin therapy, while acknowledging the ongoing uncertainties surrounding the impact of KRT on prognosis in EDKA cases.
糖尿病酮症酸中毒（DKA）通常表现为高血糖，但当患者出现酸中毒且血糖水平正常时，会发生正常血糖性糖尿病酮症酸中毒（EDKA）。这种情况因其与钠-葡萄糖协同转运蛋白-2（SGLT2）抑制剂及脓毒症等其他因素的关联而受到关注。急性肾损伤（AKI）常使脓毒症病例复杂化，并与代谢性酸中毒相关。区分AKI和EDKA可能很困难，特别是当两种情况同时出现时，如在3例伴有AKI和EDKA的脓毒症重症监护病房病例中所观察到的那样。在本报告中，强调了在危重症患者中诊断EDKA的临床挑战，尤其是在存在代谢性酸中毒和阴离子间隙升高的情况下。在这些病例中，代谢性酸中毒最初被归因于AKI；然而，血酮水平对于确诊EDKA至关重要。EDKA的治疗优先于肾脏替代治疗（KRT），后者仅在需要管理AKI时才启动。尽管KRT在管理AKI方面可能有益，但其在EDKA治疗中的作用仍需进一步研究。本报告强调了在患有脓毒症和AKI的糖尿病患者中早期诊断EDKA的重要性，强调了及时进行酮体检测和胰岛素治疗的必要性，同时也承认围绕KRT对EDKA病例预后影响的持续不确定性。
