Murat Dagdeviren1, Tolga Akkan2, Derun Taner Ertugrul3

1Department of Endocrinology and Metabolism, Ankara Etlik City Hospital, Ankara, Türkiye
2Department of Endocrinology and Metabolism, Eskisehir City Hospital, Eskisehir, Türkiye
3Department of Endocrinology and Metabolism, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Türkiye

Keywords: Diabetes mellitus, diabetic ketoacidosis, sodium‑glucose transporter 2 inhibitors


Diabetic ketoacidosis (DKA) is the most common emergency complication of diabetes. Euglycemic DKA (EDKA), on the other hand, has been known for many years but is a rare and under recognized condition and constitutes a very small proportion of DKA cases. However, in recent years, an increase in the incidence of EDKA has been observed with the widespread use of sodium–glucose co transporter 2 inhibitors, which have proven benefits in the treatment of diabetes mellitus and its cardiorenal complications, heart failure, and chronic kidney disease. Unlike classical DKA, these patients without significant hyperglycemia can easily be missed in emergency departments. EDKA should be kept in mind in patients with diabetes presenting with DKA but with a blood glucose level <250 mg/dL. The diagnostic and therapeutic approach after clinical suspicion in these patients is similar to classical DKA and is briefly summarized in this review. The most important point in treatment is that these patients are normoglycemic but have a significant insulin deficiency (relative or absolute). Therefore, insulin is the mainstay of the treatment and should be given together with dextrose solutions to avoid hypoglycemia.

How to cite this article: Dagdeviren M, Akkan T, Ertugrul DT. Re-emergence of a forgotten diabetes complication: Euglycemic diabetic ketoacidosis. Turk J Emerg Med 2024;24(1):1-7.

Author Contributions

• Murat Dagdeviren: Conceptualization, methodology, investigation, software, resources, data curation, writing – original draft
• Tolga Akkan: Conceptualization, methodology, investigation, software, resources, data curation, writing – review and editing
• Derun Taner Ertugrul: Conceptualization, methodology, investigation, writing – review and editing, supervision.

Conflict of Interest

None declared.

Financial Disclosure