{"title":"Classic diabetic ketoacidosis and the euglycemic variant: Something old, something new.","authors":"Adi E Mehta, Robert Zimmerman","doi":"10.3949/ccjm.92a.24075","DOIUrl":null,"url":null,"abstract":"<p><p>Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. With the increased use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, the variant euglycemic DKA has been described. SGLT-2 inhibitors cause a low level of ambient ketones; any additional ketone formation predisposes to ketoacidosis, while the agent's glycosuric effect limits hyperglycemia. The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. Due to the half-life of SGLT-2 inhibitors, the duration of euglycemic DKA may be more prolonged.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"33-39"},"PeriodicalIF":3.4000,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cleveland Clinic Journal of Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3949/ccjm.92a.24075","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Classic diabetic ketoacidosis and the euglycemic variant: Something old, something new.
Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. With the increased use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, the variant euglycemic DKA has been described. SGLT-2 inhibitors cause a low level of ambient ketones; any additional ketone formation predisposes to ketoacidosis, while the agent's glycosuric effect limits hyperglycemia. The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. Due to the half-life of SGLT-2 inhibitors, the duration of euglycemic DKA may be more prolonged.
期刊介绍：
The mission of Cleveland Clinic Journal of Medicine (CCJM) is to provide its readers with up-to-date, practical, clinical information relevant to internal medicine, cardiology, and related fields. Consistent with this mission, CCJM focuses on timely review articles and other content that has a continuing-education orientation rather than on original research or case reports. CCJM authors, drawn from Cleveland Clinic and other top medical institutions throughout the world, are asked to identify new findings that are changing the practice of medicine and to advise readers how to apply them in daily patient care. Authors are chosen for their experience, acquired through caring for patients, teaching other physicians, and researching clinical questions.
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