Morning Report – Euglycemic DKA

Teaching Pearls:

  • Emergent clinical manifestations of diabetes includes diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
  • DKA Manifestations
    • Presence of ketones
    • Glucose usually less than 700
    • Can present with N/V and abdominal pain
    • Acute presentation
  • HHS Manifestations
    • Lack of ketones present
    • Glucose usually greater than 700
    • Usually present with neurological changes including stupor and coma.
    • Subacute presentation
  • A small subset of DKA can present with euglycemic DKA.
    • Patients present with presence of ketones and a normal to near normal glucose levels.
    • More commonly seen in patients with poor PO intake, recent insulin use prior to ED arrival, and pregnancy state
    • Management is geared towards to decreasing ketones.
    • Other causes of anion gap are ruled out, with presence of ketones.
  • Management
    • Similar for DKA (including euglycemic) and HHS
    • Fluid resuscitation as many of these patients are hypovolemic.
    • Insulin gtt for moderate to severe manifestations
      • 0.1units/kg bolus followed by 0.1units/kg/hour or:
      • start at 0.14units/kg/hour without a bolus

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