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Complicated Acidosis Presentations: When Is Diabetic Ketoacidosis Not Diabetic Ketoacidosis? A Case Series

Published:December 12, 2022DOI:https://doi.org/10.1016/j.nurpra.2022.11.011

      Highlights

      • We present the pathophysiology, clinical presentations, and management considerations for ketoacidosis related to sodium-glucose cotransporter 2 inhibitors, pregnancy, fasting, and alcoholic acidosis.

      Abstract

      Diabetic ketoacidosis (DKA) is a common and generally well-understood medical condition in urgent and acute care centers. There are numerous conditions that have similar presentations to DKA but are better served with different treatment modalities. This article discusses the clinical presentation, diagnostic criteria, and management pearls of euglycemic DKA, alcoholic acidosis, fasting ketosis, and ketosis of pregnancy to help the reader more clearly distinguish between conditions to optimize patient care and outcomes.

      Keywords

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      References

        • Long B.
        • Lentz S.
        • Koyfman A.
        • Gottlieb M.
        Euglycemic diabetic ketoacidosis: etiologies, evaluation, and management.
        Am J Emerg Med. 2021; 44: 157-160https://doi.org/10.1016/j.ajem.2021.02.015
        • Blau J.E.
        • Tella S.H.
        • Taylor S.I.
        • Rother K.I.
        Ketoacidosis associated with SGLT2 inhibitor treatment: analysis of FAERS data.
        Diabetes Metab Res Rev. 2017; 33 (10.1002/dmrr.2924)https://doi.org/10.1002/dmrr.2924
        • Baski L.
        • Esholi T.
        • Brandstaetter E.
        • Jotkowitz A.
        Euglycemic diabetic ketoacidosis.
        Eur J Intern Med. 2019; 63: 9-14
        • Rosenstock J.
        • Ferrannini E.
        Euglycemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors.
        Diabetes Care. 2015; 38: 1638-1642
        • Wang K.M.
        • Isom R.T.
        SGLT2 inhibitor-induced euglycemic diabetic ketoacidosis: a case report.
        Kidney Med. 2020; 2: 218-221https://doi.org/10.1016/j.xkme.2019.12.006
        • Plewa M.C.
        • Bryant M.
        • King-Thiele R.
        Euglycemic Diabetic Ketoacidosis.
        StatPearls Publishing, 2022
        • Long B.L.
        • Lentz S.
        • Gottieb M.
        Alcoholic ketocacidosis: etiologies, evaluation, and management.
        J Emerg Med. 2021; 61: 658-665
        • Fulop M.
        Alcohol ketoacidosis.
        Endocrinol Metab Clin North Am. 1991; 22: 209-219
        • Höjer J.
        Alkoholketoacidos är en väl dokumenterad men tämligen okänd diagnos - Möjlig orsak till dödsfall bland personer med alkoholproblem [in Swedish].
        Lakartidningen. 2017; 114: EP6D
      1. Wolfson A.B. Hendey G.W. Ling L.J. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Lippincott, Williams and Wilkins, 2010: 1019-1021
        • Qian M.
        • Wu N.
        • Li L.
        • et al.
        Ketone body on maternal and infant outcome of pregnant women with abnormal glucose metabolism during pregnancy.
        Diabetes Metab Syndr Obes. 2020; 13: 4581-4588https://doi.org/10.2147/DMSO.S280851
      2. Dietary Guidelines for Americans, 2020-2025. 9th ed. US Department of Agriculture and US Department of Health and Human Services, 2020
        • Brouns F.
        Overweight and diabetes prevention: is a low-carbohydrate–high-fat diet recommendable?.
        Eur J Nutr. 2018; 57: 1301-1312
        • Paoli A.
        • Rubini A.
        • Volek J.S.
        • Grimaldi K.A.
        Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets.
        Eur J Clin Nutr. 2013; 67: 789-796
        • Evert A.B.
        • Dennison M.
        • Gardner C.D.
        • et al.
        Nutrition therapy for adults with diabetes or prediabetes: a consensus report.
        Diabetes Care. 2019; 42: 731-754

      Biography

      Elizabeth Bell-McClure, DNP, FNP is a clinical associate at Duke University School of Nursing in Durham, NC, and can be contacted at [email protected]

      Biography

      Valerie Sabol, PhD, ACNP-BC, GNP-BC, CNE is a professor at Duke University School of Nursing.

      Biography

      Kristen McMillan, MSN, FNP-C ia an NP at Duke University Medical Center, Durham, NC.