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Euglycaemic diabetic ketoacidosis — SCE Acute Medicine MCQ

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HardDiabetes and endocrine medicineEuglycaemic diabetic ketoacidosisSCE Acute Medicine

A 29-year-old woman with type 1 diabetes presents with vomiting and abdominal pain. She has been using an SGLT2 inhibitor started privately for weight loss. Capillary glucose is 10.8 mmol/L, ketones 6.1 mmol/L, venous pH 7.19 and bicarbonate 11 mmol/L. She is tachycardic and clinically dehydrated. What is the most appropriate next step in management?

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

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Correct answer: D — Treat as DKA with intravenous 0.9% sodium chloride and fixed-rate intravenous insulin

This is euglycaemic DKA, strongly associated with SGLT2 inhibitor exposure, and requires standard DKA treatment despite a modest glucose level. Fixed-rate IV insulin with isotonic saline is required, with glucose infusion added when needed to permit ongoing insulin. Starvation ketosis rarely produces this degree of acidosis and ketonaemia in a type 1 diabetic patient.

Reference: JBDS DKA Guideline 2023; BNF