Specimen Name Result Units Range
Plasma Sodium 129 mmol/L (135-145)
Potassium 5.3 mmol/L (3.5-5.5)
Chloride 102 mmol/L (100-109)
Bicarbonate 3 mmol/L (22-32)
Glucose 19 mmol/L (3.8-5.5)
Urea 8.6 mmol/L (2.7-7.2)
Creatinine 120 μmol/L (60-110)

19yo female.

Rapid onset of general malaise, confusion & nausea.
'Euglycaemia' Ketoacidosis
  • ≈ 2.6-3.2% of DKA admissions
  • typically younger T1DM but can occur in T2DM
  • rapid onset - within hours
  • incidence increased with SGLT2 inhibitor use
  • multiple triggers → common mechanism
    → state of starvation → euglycaemia + ketosis:
    • pregnancy
    • pancreatitis, glycogen storage disorders
    • surgery - esp. T1DM + bariatric surgery ≈ 20% of postoperative cases
    • infection
    • cocaine toxicity
    • cirrhosis
    • insulin pump use

Clinical Features:

  • Present with hyperventilation but "look well"
  • Coma and dehydration rare
  • Investigations
    • severe ketoacidosis
    • "normal" glucose: usually < 14 mmol/L (250 mg/dL), but up to 20 mmol/L
    • absence of marked hyperglycaemia:
      • state of relative starvation / rapid onset / short duration
      • normal renal function and ECF volume
      • subsequent marked glycosuria
    • osmolality only slightly elevated

 

Treatment:

  • IVT with N-saline, then D5W
  • Insulin in 'normal' doses