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Euglycaemic diabetic ketoacidosis — SCE Endocrinology MCQ

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EasyDiabetesEuglycaemic diabetic ketoacidosisSCE Endocrinology

A 55-year-old man with type 2 diabetes develops nausea, abdominal pain and ketones 4.0 mmol/L while taking empagliflozin. Glucose is 10.8 mmol/L, pH 7.19 and bicarbonate 11 mmol/L. What is the most likely diagnosis?

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Correct answer: A — Euglycaemic diabetic ketoacidosis

SGLT2 inhibitors can precipitate euglycaemic DKA, where glucose may be only modestly raised despite significant ketonaemic acidosis. HHS would feature marked hyperosmolality and much higher glucose with minimal ketones. The teaching point is to check ketones and acid-base status when symptoms fit DKA even if glucose is not very high.

Reference: JBDS DKA Guideline; BNF