Clinical Analysis of a Case of EDKA Presenting with Acute Abdomen
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v5i3.2637
Abstract
This study aims to explore the diagnostic and therapeutic methods for a patient with Euglycemic Diabetic Ketoacidosis (EDKA) presenting primarily with acute abdomen. On December 12, 2021, our hospital admitted a patient who experienced abdominal pain and vomiting after drinking alcohol. Upon admission, the patient underwent laboratory tests including blood glucose, complete blood count, renal function, liver function, cardiac enzyme profile, urinalysis, and electrolytes, as well as gastroscopy. Based on the results of blood gas analysis and urine ketone bodies, combined with a history of type 2 diabetes mellitus, alcohol consumption, and recent oral administration of dapagliflozin, the patient was diagnosed with EDKA. The treatment involved large volumes of fluid replacement and administration of insulin with glucose to clear ketones. The patient's urine ketone levels gradually returned to normal, abdominal pain symptoms were relieved, and the patient was discharged in good condition. The incidence of EDKA is relatively low, making it prone to misdiagnosis or missed diagnosis in clinical practice, which can delay treatment. Therefore, it is essential for physicians to be vigilant, integrate the results of various examinations, past medical history, and other factors for early and accurate diagnosis to formulate targeted treatment plans and improve patient prognosis.
Keywords
Diabetic Ketoacidosis; acute abdomen; diagnosis; treatment
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[1]] Muneer M, Akbar I. Acute Metabolic Emergencies in Diabetes: DKA, HHS and EDKA. Adv Exp Med Biol. 2021;1307:85-114. doi: 10.1007/5584_2020_545. PMID: 32488607.
[2] Thompson BD, Kitchen A. Euglycemic Diabetic Ketoacidosis in Type 1 Diabetes on Insulin Pump, with Acute Appendicitis: A Case Report. Clin Pract Cases Emerg Med. 2021 Aug;5(3):136-138. doi: 10.5811/cpcem.2021.1.48905. PMID: 34437030; PMCID: PMC8373175.
[3] Muppidi V, Meegada S, Challa T, Siddamreddy S, Samal S. Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection. Cureus. 2020 Mar 19;12(3):e7331. doi: 10.7759/cureus.7331. PMID: 32313772; PMCID: PMC7164719.
[4] McCabe DE, Strollo BP, Fuhrman GM. Euglycemic Diabetic Ketoacidosis in the Surgical Patient. Am Surg. 2020 Dec 14:3134820956352. doi: 10.1177/0003134820956352. Epub ahead of print. PMID: 33316172.
[5] Plewa MC, Bryant M, King-Thiele R. Euglycemic Diabetic Ketoacidosis. 2021 Nov 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32119457.
[6] Michael M, Kleophas A, Keitel V, Flügen G, Bernhard M. Vom Leitsymptom zur Diagnose: abdominelle Beschwerden [Acute Abdominal Pain in the Emergency Department]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2021 Jun;56(6):448-458. German. doi: 10.1055/a-1191-1374. Epub 2021 Jun 29. PMID: 34187077.
[7] Long B, Willis GC, Lentz S, Koyfman A, Gottlieb M. Evaluation and Management of the Critically Ill Adult With Diabetic Ketoacidosis. J Emerg Med. 2020 Sep;59(3):371-383. doi: 10.1016/j.jemermed.2020.06.059. Epub 2020 Aug 4. PMID: 32763063.
[8] Karakaya Z, Topal FE, Topal F, Payza U, Akyol PY. Euglisemic diabetic ketoacidotic coma caused by dapagliflozin. Am J Emerg Med. 2018 Nov;36(11):2136.e1-2136.e2. doi: 10.1016/j.ajem.2018.08.054. Epub 2018 Aug 21. PMID: 30150107.
[9] Muppidi V, Meegada S, Challa T, Siddamreddy S, Samal S. Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection. Cureus. 2020 Mar 19;12(3):e7331. doi: 10.7759/cureus.7331. PMID: 32313772; PMCID: PMC7164719.
[10] Steinmetz-Wood S, Gilbert M, Menson K. A Case of Diabetic Ketoacidosis in a Patient on an SGLT2 Inhibitor and a Ketogenic Diet: A Critical Trio Not to Be Missed. Case Rep Endocrinol. 2020 Aug 13;2020:8832833. doi: 10.1155/2020/8832833. PMID: 32855828; PMCID: PMC7443033.
[11] Yu X, Zhang S, Zhang L. Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis. Int J Endocrinol. 2018 Oct 2;2018:7074868. doi: 10.1155/2018/7074868. PMID: 30369948; PMCID: PMC6189664.
[12] Long B, Lentz S, Koyfman A, Gottlieb M. Euglycemic diabetic ketoacidosis: Etiologies, evaluation, and management. Am J Emerg Med. 2021 Jun;44:157-160. doi: 10.1016/j.ajem.2021.02.015. Epub 2021 Feb 16. PMID: 33626481.
[13] Rawla P, Vellipuram AR, Bandaru SS, Pradeep Raj J. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinol Diabetes Metab Case Rep. 2017 Sep 4;2017:17-0081. doi: 10.1530/EDM-17-0081. PMID: 28924481; PMCID: PMC5592704.
[2] Thompson BD, Kitchen A. Euglycemic Diabetic Ketoacidosis in Type 1 Diabetes on Insulin Pump, with Acute Appendicitis: A Case Report. Clin Pract Cases Emerg Med. 2021 Aug;5(3):136-138. doi: 10.5811/cpcem.2021.1.48905. PMID: 34437030; PMCID: PMC8373175.
[3] Muppidi V, Meegada S, Challa T, Siddamreddy S, Samal S. Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection. Cureus. 2020 Mar 19;12(3):e7331. doi: 10.7759/cureus.7331. PMID: 32313772; PMCID: PMC7164719.
[4] McCabe DE, Strollo BP, Fuhrman GM. Euglycemic Diabetic Ketoacidosis in the Surgical Patient. Am Surg. 2020 Dec 14:3134820956352. doi: 10.1177/0003134820956352. Epub ahead of print. PMID: 33316172.
[5] Plewa MC, Bryant M, King-Thiele R. Euglycemic Diabetic Ketoacidosis. 2021 Nov 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32119457.
[6] Michael M, Kleophas A, Keitel V, Flügen G, Bernhard M. Vom Leitsymptom zur Diagnose: abdominelle Beschwerden [Acute Abdominal Pain in the Emergency Department]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2021 Jun;56(6):448-458. German. doi: 10.1055/a-1191-1374. Epub 2021 Jun 29. PMID: 34187077.
[7] Long B, Willis GC, Lentz S, Koyfman A, Gottlieb M. Evaluation and Management of the Critically Ill Adult With Diabetic Ketoacidosis. J Emerg Med. 2020 Sep;59(3):371-383. doi: 10.1016/j.jemermed.2020.06.059. Epub 2020 Aug 4. PMID: 32763063.
[8] Karakaya Z, Topal FE, Topal F, Payza U, Akyol PY. Euglisemic diabetic ketoacidotic coma caused by dapagliflozin. Am J Emerg Med. 2018 Nov;36(11):2136.e1-2136.e2. doi: 10.1016/j.ajem.2018.08.054. Epub 2018 Aug 21. PMID: 30150107.
[9] Muppidi V, Meegada S, Challa T, Siddamreddy S, Samal S. Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection. Cureus. 2020 Mar 19;12(3):e7331. doi: 10.7759/cureus.7331. PMID: 32313772; PMCID: PMC7164719.
[10] Steinmetz-Wood S, Gilbert M, Menson K. A Case of Diabetic Ketoacidosis in a Patient on an SGLT2 Inhibitor and a Ketogenic Diet: A Critical Trio Not to Be Missed. Case Rep Endocrinol. 2020 Aug 13;2020:8832833. doi: 10.1155/2020/8832833. PMID: 32855828; PMCID: PMC7443033.
[11] Yu X, Zhang S, Zhang L. Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis. Int J Endocrinol. 2018 Oct 2;2018:7074868. doi: 10.1155/2018/7074868. PMID: 30369948; PMCID: PMC6189664.
[12] Long B, Lentz S, Koyfman A, Gottlieb M. Euglycemic diabetic ketoacidosis: Etiologies, evaluation, and management. Am J Emerg Med. 2021 Jun;44:157-160. doi: 10.1016/j.ajem.2021.02.015. Epub 2021 Feb 16. PMID: 33626481.
[13] Rawla P, Vellipuram AR, Bandaru SS, Pradeep Raj J. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinol Diabetes Metab Case Rep. 2017 Sep 4;2017:17-0081. doi: 10.1530/EDM-17-0081. PMID: 28924481; PMCID: PMC5592704.
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