Case of the Month #44 High Anion Gap Metabolic Acidosis

Published 12/10/2023

What is euglycaemic DKA?

  • The presence of ketoacidosis in a patient with diabetes, but without significant hyperglycaemia (<11 mmol/L).
  • Associated causes include: pregnancy, starvation, high alcohol consumption, insulin use, sepsis and liver disease.
  • Another cause is the use of sodium-glucose transporter 2 inhibitors such as canagliflozin, dapagliflozin, empagliflozin and ertugliflozin.
  • Of those developing DKA who take a SGLT2-inhibitor, 60% will present with euglycaemia.
  • This medication class prevents reabsorption of glucose in the proximal convoluted tubule, promoting glycosuria and causing polyuria. They stimulate glucagon release and suppress insulin production leading to lipolysis and ketogenesis.
  • This is the most likely cause in this case.