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Ketoacidosis in Euglycemic Patients With Type 2 Diabetes After Abdominal Surgery
Author(s) -
Segebrecht Ray,
Moncure Michael,
Bennett Ashley,
Geehan Douglas,
Van Way Charles W.,
Weide Lamont
Publication year - 2019
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1594
Subject(s) - diabetic ketoacidosis , metabolic acidosis , medicine , anion gap , ketoacidosis , type 2 diabetes , acidosis , diabetes mellitus , bicarbonate , complication , type 1 diabetes , endocrinology , intensive care unit , gastroenterology
Diabetic ketoacidosis is defined as hyperglycemia >250 mg/dL with metabolic acidosis of arterial pH <7.3, serum bicarbonate <18 mEq/L with positive urine and serum ketones and an anion gap >10. Euglycemic ketoacidosis has been reported in patients with type 2 diabetes and in patients with type 1 diabetes. However, as a surgical complication, euglycemic ketoacidosis has not been reported. We report 2 cases from 2 teaching tertiary care centers of patients with type 2 diabetes who developed high‐gap ketoacidosis in an intensive care unit while recovering from emergent abdominal surgery. Both patients developed altered mental status, metabolic acidosis with a bicarbonate level as low as 14 mEq/L, and an anion gap > 18, without hyperglycemia. Both patients had β‐hydroxybutyrate levels > 5 mmol/L.