Shammas Isam, Seyaj Mohammed, Altell Kenana, Sobeih Razan, Asafrah Lara, Burqan Malek, Abuhalawa Mamoun, Shahateet Mohammed, Itkaidek Saeed
Department of Surgical ICU, Al-Ahli Hospital, Hebron, State of Palestine.
Department of Medicine, Hebron University, Hebron, State of Palestine.
Medicine (Baltimore). 2025 Jul 25;104(30):e43562. doi: 10.1097/MD.0000000000043562.
Euglycemic diabetic ketoacidosis (EuDKA) is a rare variant of diabetic ketoacidosis (DKA), characterized by normal or near-normal glucose levels despite severe metabolic acidosis and ketosis. This condition poses a diagnostic challenge as it mimics DKA without the hallmark hyperglycemia. Recent studies have suggested an association between EuDKA and newer antidiabetic medications, including dipeptidyl peptidase-4 (DPP-4) inhibitors.
A 57-year-old male with a history of type 2 diabetes, hypertension, ischemic heart disease, and rheumatoid arthritis developed EuDKA following a traumatic brain injury. Despite a blood glucose of 134 mg/dL, he exhibited classic features of DKA, including severe metabolic acidosis, low bicarbonate levels, an elevated anion gap, and positive urinary ketones.
Despite the blood glucose level being within normal range, the patient's clinical presentation, including severe acidosis (pH 7.16), low bicarbonate (2.8 mmol/L), elevated anion gap (24.9 mmol/L), and urinary ketones, pointed to EuDKA. The patient's use of Sitagliptin, a DPP-4 inhibitor, was identified as a likely precipitating factor.
Timely interventions, including fluid resuscitation, insulin therapy, and electrolyte correction, were promptly administered to manage the patient's metabolic abnormalities.
After receiving intensive treatment, the patient made a full recovery with normalization of metabolic parameters and no long-term complications.
This case emphasizes the importance of maintaining a high index of suspicion for EuDKA in trauma patients, particularly those on DPP-4 inhibitors. Early recognition and prompt intervention are crucial to preventing complications and ensuring positive outcomes. Further research is needed to explore the mechanisms linking DPP-4 inhibitors with EuDKA, especially in the context of metabolic stress like traumatic brain injury.
正常血糖性糖尿病酮症酸中毒（EuDKA）是糖尿病酮症酸中毒（DKA）的一种罕见变体，其特征是尽管存在严重代谢性酸中毒和酮症，但血糖水平正常或接近正常。这种情况带来了诊断挑战，因为它在没有典型高血糖的情况下类似DKA。最近的研究表明EuDKA与新型抗糖尿病药物之间存在关联，包括二肽基肽酶-4（DPP-4）抑制剂。
一名57岁男性，有2型糖尿病、高血压、缺血性心脏病和类风湿关节炎病史，在颅脑外伤后发生了EuDKA。尽管血糖为134mg/dL，但他表现出DKA的典型特征，包括严重代谢性酸中毒、低碳酸氢盐水平、升高的阴离子间隙和尿酮阳性。
尽管血糖水平在正常范围内，但患者的临床表现，包括严重酸中毒（pH 7.16）、低碳酸氢盐（2.8mmol/L）、升高的阴离子间隙（24.9mmol/L）和尿酮，指向EuDKA。患者使用的DPP-4抑制剂西他列汀被确定为可能的诱发因素。
及时给予包括液体复苏、胰岛素治疗和电解质纠正在内的干预措施，以管理患者的代谢异常。
经过强化治疗，患者完全康复，代谢参数恢复正常，无长期并发症。
该病例强调了对创伤患者，尤其是使用DPP-4抑制剂的患者，保持对EuDKA高度怀疑指数的重要性。早期识别和及时干预对于预防并发症和确保良好结局至关重要。需要进一步研究来探索DPP-4抑制剂与EuDKA之间的联系机制，特别是在像颅脑外伤这样的代谢应激情况下。
