Pinedo LM, Vázquez RR, Murillo CP

Language: Spanish
References: 16
Page: 245-248
PDF size: 126.16 Kb.

ABSTRACT

Diabetic ketoacidosis is an acute complication of diabetes, characterized by metabolic acidosis with an increase in the values of anion gap and evidence of ketone bodies in blood or urine. In most cases, it is present with hyperglycemia. Euglycemic diabetic ketoacidosis is defined by the triad of glucose with values < than 200 mg/dL, metabolic acidosis with high anion gap and ketonemia. The factors associated with this entity are pregnancy, treatment with SGLT2, decrease in caloric intake, liver disease, chronic alcohol intake, use of insulin prior to hospitalization, sepsis, pancreatitis, increase in counter-regulatory hormones and perioperative states. The basis of the treatment is the rapid correction of dehydration with intravenous fluids, as well as the use of insulin drip along with a solution containing dextrose until the anion gap, and bicarbonate levels normalize. In this article, a case of a patient admitted to the ICU in the immediate perioperative period is reported.

REFERENCES

1. Lucero P, Chapela S. Euglycemic diabetic ketoacidosis in the ICU: 3 case reports and review of literature. Case Rep Crit Care. 2018;2018:1-6.

2. Barski L, Eshkoli T, Brandstaetter E, Jotkowitz A. Euglycemic diabetic ketoacidosis. Eur J Intern Med. 2019;63:9-14.

3. Meyer E, Gabb G, Jesudason D. SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis: a south Australian clinical case series and Australian spontaneous adverse event notifications. Diabetes Care. 2018;41(4):e47-e49.

4. Karslioglu French E, Donihi A, Korytkowski M. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019;365:|1114.

5. Rawla P, Vellipuram A, Bandaru S, Pradeep Raj J. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinol Diabetes Metab Case Rep. 2017;2017:17-0081.

6. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343.

7. Savage M, Dhatariya K, Kilvert A, Rayman G, Rees J, Courtney C, et al. Hilton L, Dyer P. and Hamersley, M. Joint British diabetes societies guideline for the management of diabetic ketoacidosis. Diabet Med. 2011;28(5):508-515.

8. Munro JF, Campbell IW. Euglycaemic diabetic ketoacidosis. Br Med J. 1973;2:578-580.

9. Qiu H, Novikov A, Vallon V. Ketosis and diabetic ketoacidosis in response to SGLT2 inhibitors: basic mechanisms and therapeutic perspectives. Diabetes Metab Res Rev. 2017;33(5):2886.

10. Burge M, Hardy K, Schade D. Short-term fasting is a mechanism for the development of euglycemic ketoacidosis during periods of insulin deficiency. J Clin Endocrinol Metab. 1993;76(5):1192-1198.

11. Ogawa W, Sakaguchi K. Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. J Diabetes Investig. 2015;7(2):135-138.

12. Kerr D, Wenham T, Munir A. Endocrine problems in the critically ill 1: diabetes and glycaemic control. BJA Education. 2017;17(11):370-377.

13. Yee A, Burns J, Wijdicks E. Cerebral salt wasting: pathophysiology, diagnosis, and treatment. Neurosurg Clin N Am. 2010;21(2):339-352.

14. Cuesta M, Hannon MJ, Thompson CJ. Diagnosis and treatment of hyponetraemia in neurosurgical patients. Endorinol Nutr. 2016;63(5):230-238.

15. Robinson AG, Verbalis JG. Posterior pituitary. Chapter 10, Williams Textbook of Endocrinology. 2016, pp. 300-332.

16. Joseph F, Anderson L, Goenka N, Vora J. Starvation-induced true diabetic euglycemic ketoacidosis in severe depression. J Gen Intern Med. 2009;24(1):129-131. https://doi.org/10.1007/s11606-008-0829-0.