Euglycemic Diabetic Ketoacidosis (EDKA) can occur in some diabetics. It may be misdiagnosed if the clinician requires hyperglycemia for a diagnosis of diabetic ketoacidosis or if the clinician is unaware of possible risk factors.

Proposed mechanism:

(1) lower excess glucose production

(2) higher renal glucose clearance



(1) history of diabetes

(2) ketoacidosis with high anion gap metabolic acidosis and elevated serum ketones

(3) blood glucose at presentation < 300 mg/dL (other use cutoff < 250 mg/dL, < 200 mg/dL or <180 mg/dL), with prevalence decreasing with lower thresholds


Risk factors for EDKA may include:

(1) pregnancy

(2) starvation

(3) pancreatitis

(4) severe liver disease

(5) inborn error of metabolism

(6) glycogen storage disease

(7) therapy with SGLT2 (sodium-glucose transport protein 2) inhibitor, typically with (ketogenic diet or very low carbohydrate diet)

(8) alcohol abuse

(9) massive stroke

(10) postoperative state

(11) protracted vomiting

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