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
Features:
(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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