Poster Abstract Abstract
(Adults - Diabetes mellitus), #220519736458
Euglycaemic DKA cases: two cautionary tales
Abdullah Shamshir Abd Mokti, Endocrine unit, Medical Department, Hospital Tengku Ampuan Afzan, Kuantan; Miza Hiryanti Zakaria, Endocrine unit, Medical Department, Hospital Tengku Ampuan Afzan, Kuantan
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Euglycaemic diabetic ketoacidosis (euDKA) is a triad of high anion gap metabolic acidosis, ketonemia and normal blood glucose. It has been increasingly reported with the increase use of SGLT-2 inhibitors. Here, we describe 2 euDKA cases of different aetiologies.
The first case is a 29-year old pregnant lady with Type 1 diabetes diagnosed at 8 years old with good control pre-partum (HbA1C 6.8%) and only 1 previous DKA at diagnosis. During pregnancy, glycaemic control worsened requiring high doses of insulin. She presented at 33 weeks of gestation with reduced fetal movement alongside epigastric discomfort, vomiting and dyspnoea. Ultrasound by obstetrician revealed no fetal movement and investigations showed high anion gap metabolic acidosis with pH 6.9, bicarbonate 12nmol/l while capillary blood glucose (CBG) was 10.3mmol/l and serum ketone 6.5mmol/l. EuDKA precipitated by intrauterine death was diagnosed, treatment was started and proceeded with C-section. Postoperatively, acidosis and ketonaemia resolved and CBG was able to be controlled with low dose insulin.
The second case is a 56-year old lady with poorly-controlled type 2 Diabetes (HbA1C 12%) who was diagnosed with upper gastrointestinal bleed. Blood investigations showed CBG 8.5 mmol/l, and normal blood gasses with disproportionate urea:creatinine ratio. She was kept nil-by-mouth while waiting for gastroscopy. Eight hours later as she developed tachypnoea and worsening epigastric pain; repeated blood investigations showed pH 7.0, bicarbonate 17nmol/l, CBG 11mmol/l and serum ketone 4.3mmol/l. EuDKA was diagnosed and she was treated promptly and acidosis and ketonaemia resolved
These 2 cases illustrate the need for high index of suspicion for euDKA in diabetics undergoing stressful condition and the importance of measuring serum ketone in metabolic acidosis even in patient with normal blood glucose.