Advanced Practice: Euglycemic DKA!
Euglycemic Diabetic Ketoacidosis
Serum ketones + metabolic acidosis without the typical elevated blood sugars we see in Diabetic Ketoacidosis (DKA)
- SGLT-2 inhibitors – medication that end in “–gliflozin”
- Dehydration or decreased PO or ETOH abuse
- Concurrent illness
SGLT-2 inhibitors prevent glucose reabsorption from proximal renal tubules
-->glucosuria suppresses insulin release
-->relative insulin deficiency leads to lipolysis, free fatty acid oxidation
- Suspect euDKA in any T1DM or T2DM who presents with epigastric pain, nausea, vomiting, shortness of breath or found to have a metabolic acidosis
- These patients should get a serum ketones drawn
- Difficult to distinguish from alcoholic ketoacidosis --> check med list
- Same as typical DKA management but start D5 earlier because starting with glucose of 200 to 300.
- Consider discontinuing SGLT-2 inhibitor ideally in conjunction with PCP
https://www.uptodate.com/contents/sodium-glucose- co-transporter- 2- inhibitors-for- the-treatment- of-type- 2-diabetes-
http://empharmd.blogspot.com/2016/05/euglycemic-dka- from-sglt2- inhibitors.html