PT  - JOURNAL ARTICLE
AU  - Mehta, Adi E.
AU  - Zimmerman, Robert
TI  - Classic diabetic ketoacidosis and the euglycemic variant: Something old, something new
AID  - 10.3949/ccjm.92a.24075
DP  - 2025 Jan 01
TA  - Cleveland Clinic Journal of Medicine
PG  - 33--39
VI  - 92
IP  - 1
4099  - http://www.ccjm.org/content/92/1/33.short
4100  - http://www.ccjm.org/content/92/1/33.full
SO  - Cleve Clin J Med2025 Jan 01; 92
AB  - 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.