Euglycemic diabetic ketoacidosis (EDKA) is a rare complication of diabetes associated with various risk factors like fasting, surgery, pregnancy, and the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Euglycemic diabetic ketoacidosis occurs mainly due to the imbalance between insulin and counterregulatory hormones. It can occur in both type 1 and type 2 diabetes mellitus. It is characterized by euglycemia associated with severe metabolic acidosis and ketosis. Diagnosis is very exigent due to its varied etiology and uncommon presentation with normal blood glucose levels resulting in delayed recognition. Hence, it is very important to suspect and diagnose at an early stage to prevent its complications. In our case report, we present a challenging case of postoperative EDKA not associated with the association of SGLT-2 inhibitors.
Modi A, Agrawal A, Morgan F. Euglycemic diabetic ketoacidosis: a review. Curr Diabetes Rev 2017;13:315–321. DOI: 10.2174/1573399812666160421121307
Munro JF, Campbell IW, McCuish AC, et al. Euglycaemic diabetic ketoacidosis. Br Med J 1973;2:578–580. DOI: 10.1136/bmj.2.5866.578
Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: an update of its etiology, pathogenesis and management. Metabolism 2016;65 507–521. DOI: 10.1016/j.metabol.2015.12.007
Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev 1999;15:412–426. DOI: 10.1002/(sici)1520-7560(199911/12)15:6<412::aid-dmrr72>3.0.co;2-8
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32:1335–1343. DOI: 10.2337/dbib9-9032
Barski L, Eshkoli T, Brandstaetter E, et al. Euglycemic diabetic ketoacidosis. Eur J Intern Med 2019;63:9–14. DOI: 10.1016/j.ejim.2019.03.014
Rawla P, Vellipuram AR, Bandaru SS, et al. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinol Diabetes Metab Case Rep 2017;2017:17–81. DOI: 10.1530/EDM-17-0081
Gelaye A, Haidar A, Kassab C, et al. Severe ketoacidosis associated with canagliflozin (Invokana): a safety concern. Case Rep Crit Care 2016;2016:1656182. DOI: 10.1155/2016/1656182
Rosenstock J, Ferrannini E. Euglycemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors. Diabetes Care 2015;38:1638–1642. DOI: 10.2337/dc15-1380
