Euglycemic Diabetic Ketoacidosis with Acute Pancreatitis in a Patient Not Known to Have Diabetes

ABSTRACT Objective: Euglycemic diabetic ketoacidosis (DKA) is a less known presentation of DKA. The aim of this case report is to alert physicians to the possibility of euglycemic DKA in a female patient presenting with metabolic ketoacidosis and to highlight the complex physiologic interplay between severe alcohol-related pancreatic injury, ketoacidosis, and starvation. Methods: We describe a patient with a known history of alcoholism who presented with metabolic acidosis and acute pancreatitis and was not known to have diabetes. Results: Computed tomography (CT) of the abdomen showed severe pancreatitis. The patient had not eaten for over 1 week. Laboratory work-up showed severe metabolic acidosis and no alcohol. Her acidosis improved only after euglycemic DKA was suspected; intravenous (IV) insulin infusion and dextrose were initiated, and her fluid/electrolyte abnormalities and carbohydrate metabolism were normalized. Conclusion: Euglycemic DKA occurs in a small subset of patients with DKA and can go undiagnosed at initial presentation. It is thought to be due to starvation and food restriction, which inhibits gluconeogenesis, and is mainly observed in patients with a history of diabetes and insulin deficiency. Abbreviations: AKA alcoholic ketoacidosis DKA diabetic ketoacidosis HbA1c glycated hemoglobin A1c IV intravenous