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Diabetic Ketoacidosis — UKMLA MCQ

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HardEndocrinologyDiabetic KetoacidosisUKMLAMRCP Part 1MRCEM SBAPARAPSA

A patient taking an SGLT2 inhibitor has nausea, abdominal pain, ketones 5.2 mmol/L and pH 7.21, but glucose is only 9.8 mmol/L. What is the correct interpretation and management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Euglycaemic DKA; stop SGLT2 and commence DKA treatment

The best answer is “Euglycaemic DKA; stop SGLT2 and commence DKA treatment”. SGLT2 inhibitors can cause euglycaemic DKA, so substantial ketonaemia and metabolic acidosis establish the emergency despite modest glucose. The medicine is stopped and standard DKA treatment uses fluids, fixed-rate IV insulin, potassium management and earlier glucose infusion as needed to permit continued ketone clearance. Oral correction or bicarbonate alone does not reverse the underlying ketogenesis.

Reference: JBDS-IP, The Management of Diabetic Ketoacidosis in Adults: https://abcd.care/sites/default/files/site_uploads/JBDS_Guidelines_Current/JBDS_02_DKA_Guideline_with_QR_code_March_2023.pdf