Perioperative diagnosis of euglycaemic ketoacidosis

Yeow, C.; Wilson, Frederick J. F.; Walter, Edward; Sultan, Javed

doi:10.1177/1751143715595050

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…Meanwhile, carbohydrate deficit and continued insulin treatment facilitate “euglycemia” ( Figure 1 ). A well-known aetiology of EDKA includes pregnancy [ 16 , 23 ], glycogen storage disorders [ 13 , 24 ], diet restriction/starvation [ 12 , 13 ], and alcohol and SGLT-2 inhibition [ 7 , 16 ]. However, the mechanism is not without doubt.…”

Section: Discussionmentioning

confidence: 99%

“…There used to be much emphasis on the distinction between starvation ketoacidosis and EDKA asserting that the latter distinctively results from severe insulin deficiency [ 24 , 40 ]. SGLT-2 inhibitor-associated EDKA challenges this guardian meaning of being “diabetic.” Interestingly enough, some true EDKA was actually a “starvation” one that happened in a diabetic population [ 12 ]. It is not irrational to say that the differential is somehow of nomenclature and is conditional.…”

Section: Discussionmentioning

confidence: 99%

“…Starvation-induced ketosis rarely develops to the stage of severe ketoacidosis in a non-insulin-dependent diabetic patient. Precipitants like muscle dystrophy [ 12 ], significant weight loss (sarcopenia) [ 11 ], and chronic liver disease [ 24 ] aggravate glycogen depletion and curtail gluconeogenesis with less substrates and poor liver function reserve. Glucose deficit outraces the compensatory insulin resistance and increased EGP.…”

Section: Discussionmentioning

confidence: 99%

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Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis

Zhang

2018

International Journal of Endocrinology

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Euglycemic diabetic ketoacidosis (EDKA) was considered a rare condition with its specific definition and precipitating factors. However, with the wide use of sodium glucose cotransporter 2 (SGLT-2) inhibitors, the newest class of antidiabetic agents, EDKA has come back into the spotlight. Relevant cases are increasingly being reported along with insights into the mechanism of EDKA. It seems increasingly clear that EDKA is more common than we used to believe. The SGLT-2 inhibitor-associated EDKA also indicates a necessary review of our previous understanding of “diabetic” ketoacidosis, since the SGLT-2 inhibitor predisposes patients to DKA in a “starvation” way. Actually, there are growing reports about starvation-induced ketoacidosis as well. The previously “exclusive” nomenclature and cognition of these entities need to be reexamined. That the hormonal interactions in DKA may differ from the severity of insulin deficiency also may have served in the scenario of EDKA. The SGLT-2 inhibitors are newly approved in China. The main purpose of this work is to have a better understanding of the situation and update our knowledge with a focus on the pathogenesis of EDKA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis

Zhang

2018

International Journal of Endocrinology

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“…The driver for ketone production in patients with SKA is a state of carbohydrate depletion, initial management therefore centres Starvation ketoacidosis a combination of IV dextrose, careful monitoring and appropriate replacement of electrolytes. 3 It is important to screen for SKA in patients with an unexplained metabolic acidosis by checking capillary glucose and ketone measures, both of which are readily available in emergency departments and acute medical wards. Furthermore, one must bear in mind that a lactic acidosis can coexist with a ketoacidosis and therefore consider checking ketones even if lactate is raised.…”

Section: Initial Management and Prognosismentioning

confidence: 99%

Starvation ketoacidosis on the acute medical take

2020

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Starvation ketoacidosis (SKA) represents one of three metabolic acidoses caused by the accumulation of ketone bodies within the bloodstream. While easily treated, it is a diagnosis that can be easily missed in patients with an unexplained metabolic acidosis. In this case report, we discuss two patients presenting with a starvation ketoacidosis and psychiatric illness. This link between SKA and psychiatric disease is especially pertinent as this is a cohort of patients who may not be able to give an accurate history, which can potentially lead to a delay in diagnosis and treatment. Furthermore, the patient cohort described here have higher rates of alcohol dependence and are therefore at risk of alcoholic ketoacidosis. It is important to recognise that these conditions may coexist and should be managed as such, with thiamine prior to carbohydrate replacement in all at-risk patients.

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“…Dear Editor, Yeow et al 1 describe a case of non-diabetic euglycaemic acidosis resulting from post op dysphagia and poor intake of approximately six weeks duration. We have seen a similar case of 'starvation ketoacidosis' in a patient undergoing percutaneous endoscopic gastrostomy feeding tube replacement.…”

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confidence: 99%

Starvation ketoacidosis: Treatment pitfalls

Hammerbeck

Holland

2017

Journal of the Intensive Care Society

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Dear Editor, Yeow et al. 1 describe a case of non-diabetic euglycaemic acidosis resulting from post op dysphagia and poor intake of approximately six weeks duration. We have seen a similar case of 'starvation ketoacidosis' in a patient undergoing percutaneous endoscopic gastrostomy feeding tube replacement. We think that intravenous (IV) glucose should be the initial treatment, with the addition of insulin only if required. The correspondence from Frise and Mackillop 2 states this strategy is effective for treating ketoacidosis in pregnancy; however, there are also some other pitfalls in treatment of starvation ketoacidosis which must be considered, and some overlap with alcoholic ketoacidosis. Unlike patients with diabetic ketoacidosis, patients with starvation ketosis release insulin when carbohydrate is administered. They are also producing high levels of glucose elevating hormones such as glucagon and have depleted glycogen stores. These hormones cause the lipolysis which helps generate ketones for fuel. The addition of exogenous insulin in this state risks hypoglycaemia. Once provided with adequate carbohydrate the insulin levels will rise and counterregulatory hormone levels will fall, resolving the ketosis. Alcoholics are another group prone to ketosis (alcoholic ketoacidosis (AKA)) and are particularly prone to hypoglycaemia; administration of insulin to those patients would have to be with caution and literature 3 on AKA reports resolution without insulin administration, although there is little evidence outside of case reports.

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Perioperative diagnosis of euglycaemic ketoacidosis

Cited by 9 publications

References 13 publications

Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis

Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis

Starvation ketoacidosis on the acute medical take

Starvation ketoacidosis: Treatment pitfalls

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