Atif Usman et al: Euglycemia; A hideout for Diabetic ketoacidosis

An episode of diabetic ketoacidosis is normally initiated with hyperglycemia. However, hyperglycemia may not always be an indicator as ketoacidosis can occur with normal glycemic level as well. An elderly female with Chinese origin and history of type II diabetes, hypertension, dyslipidemia and ischemic heart disease was admitted to hospital with complaint of fever, urinary inconsistency and loose stool. Upon investigation, patient had higher values for capillary glucose, platelets and white blood count and lower values of sodium, potassium and red blood count. Treatment was initiated for gastroenteritis, urinary retention and anemia but patient developed metabolic acidosis which got severe after some time. Patient died later with death note of diabetic ketoacidosis secondary to sepsis. Euglycemic diabetic ketoacidosis is a well defined phenomenon. Patient in this case was however mildly hyperglycemic but was not given insulin. Alongside sepsis, increase in white blood count is also an attribute of dehydration and once diabetic ketoacidosis was ruled in, the rate of fluid resuscitation was not maintained as recommended by guidelines. Outcome of all these factors result in the death of patient. Hereby, we emphasize that guidelines for diagnosis of diabetic ketoacidosis should be applied upon every diabetic admission and followed during the management afterwards.