Euglycemic diabetic ketoacidosis (DKA) is a life-threatening endocrinological emergency characterized differently from its typical counterpart by normalized or slightly elevated plasma levels of glucose, defined as less than 200 mg per dL, which can result in a delay of diagnosis and treatment. This condition can occur in both type 1 and type 2 diabetes mellitus. Common causes of euglycemic DKA include prescription and use of sodium glucose cotransporter-2 inhibitors (SGLT-2i), pregnancy, glycogen storage diseases, diet restriction, starvation, and states of stress such as post-operative states, acute pancreatitis, infections, and intercurrent illnesses. As with DKA, patients with euglycemic DKA also require immediate emergency evaluation and treatments including rapid correction of dehydration along with correction of electrolytes and use of continuous intravenous insulin with a dextrose infusion until the blood glucose is controlled, the wide anion gap metabolic acidosis is resolved, and the ketone values are normalized. This article includes the definition, epidemiology, pathogenesis, diagnosis, differential diagnosis, and management of euglycemic DKA to enlighten clinicians on the awareness of this condition.

Keywords: Euglycemia, Acidosis, Diabetes, Emergency, Sodium glucose co-transportor-2 inhibitors

Received 24 Oct 2019 | Revised 27 Dec 2019 | Accepted 2 Jan 2020