Euglycemic Diabetic Ketoacidosis: Clinical Insights From a Tertiary-Centre Cohort
https://doi.org/10.15605/jafes.041.S1
- Author:
Jia Ling Loh
1
;
Chin Voon Tong
1
;
Lisa Mohamed Nor
2
Author Information
1. Institut Endokrin, Hospital Putrajaya
2. Clinical Research Centre, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Diabetic Ketoacidosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):46-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Euglycemic diabetic ketoacidosis (EDKA) is an uncommon
but potentially life-threatening complication of diabetes,
characterized by significant ketoacidosis in the absence
of marked hyperglycemia. The increasing use of sodiumglucose co-transporter-2 inhibitors (SGLT2i) has contributed
to its rising incidence; however, data describing its clinical
spectrum remain limited.
Methodology:We conducted a retrospective observational study of 19
patients admitted for EDKA between 2002 and 2025. EDKA
was defined as metabolic acidosis with ketosis in the presence
of blood glucose <11 mmol/L. Demographic characteristics, comorbidities, biochemical parameters, triggers,
and clinical outcomes were analyzed. Continuous variables
were reported as mean (SD) or median (interquartile
range [IQR]), and categorical variables as frequencies and
percentages.
Results:The cohort displayed a mean age of 52 (SD 22.2) years,
with a slight female predominance (52.6%). The majority
had underlying type 2 diabetes mellitus (89.5%). Other
comorbidities include hypertension (63.2%) and chronic
kidney disease (31.6%). Despite severe metabolic
derangement, the mean blood glucose at presentation
was modest at 9.3 (SD 3.38) mmol/L. Median pH was 7.1
(IQR 0.35) and bicarbonate 9.1 mmol/L, with a markedly
elevated median anion gap of 25.3 mmol/L. SGLT2i exposure was identified in 47.4% of patients,
predominantly empagliflozin, with most initiated within
6 months. Nevertheless, infection was still the leading
precipitant (68.4%), while 31.6% were adjudicated as having
SGLT2i as the primary precipitating factor, probably due
to underreporting during the diagnosis. Nearly half of the
patients required intensive care (47.4%). The mean time to
DKA resolution was 19 (SD 10.1) hours. Overall outcomes
were favorable, with 89.5% of patients discharged and a
mortality rate of 10.5%.
Conclusion:EDKA presents with severe metabolic acidosis despite
deceptively normal glucose levels, increasing the risk of
delayed recognition. Early assessment of ketones and acid–
base status is essential in patients with diabetes presenting
with unexplained metabolic acidosis, particularly among
those receiving SGLT2 inhibitors, to facilitate timely
diagnosis and management.
- Full text:2026073010533551387EP_A048.pdf
