Euglycaemic diabetic ketoacidosis: does it exist?

• Published in: Acta diabetologica 1993, Vol.30 (4), p.251-253
• Main Authors: JENKINS, D, CLOSE, C. F, KRENTZ, A. J, NATTRASS, M, WRIGHT, A. D
• Format: Article
• Language: English
• Subjects: Associated diseases and complications; Bicarbonates - blood; Biological and medical sciences; Blood Glucose - metabolism; Diabetes. Impaired glucose tolerance; Diabetic Ketoacidosis - blood; Diabetic Ketoacidosis - diagnosis; Diabetic Ketoacidosis - drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Humans; Insulin - therapeutic use; Ketone Bodies - urine; Medical sciences; Retrospective Studies
• ISSN: 0940-5429; 1432-5233
• DOI: 10.1007/BF00569937

The original criteria described for euglycaemic ketoacidosis (initial blood glucose less than 16.7 mmol/l and plasma bicarbonate equal to or less than 10 mmol/l) were identified in 23 of 722 consecutive episodes (3.2%) of diabetic ketoacidosis. True euglycaemic ketoacidosis (initial blood glucose 10 mmol/l or less) was rare, occurring in 0.8-1.1% of all episodes depending on the defining plasma bicarbonate concentration. Management of euglycaemic ketoacidosis with low-dose continuous intravenous infusion of insulin together with adequate fluid replacement was effective. The clinical and biochemical data did not support the concept of euglycaemic ketoacidosis as a separate entity. The importance of ketone testing rather than glucose testing in the diagnosis of ketoacidosis is, however, emphasized. The importance of adequate insulin and fluid therapy in those few episodes where blood glucose is normal or near normal at presentation is also highlighted.