2023 Volume 66 Issue 5 Pages 359-363
Differentiating between alcoholic ketoacidosis (AKA) and euglycemic diabetic ketoacidosis (euDKA) is difficult, as both feature metabolic acidosis with an increased anion gap without hyperglycemia. A 51-year-old man who had been a heavy drinker was admitted to our hospital because of thirst and palpitations. He had regularly consumed more than 50 g of alcohol per day for a number of years. He also had a history of type 2 diabetes, which was being treated with empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor. At admission, his blood pH was 7.261, and his HCO3− level was 14.0 mmol/L. The anion gap was elevated (25.2 mmol/L), as were lactate levels (5.1 mmol/L), but blood glucose was not (79 mg/dL). Initially, AKA was suspected, and treatment was started with fluid transfusion and thiamine. However, eight hours after admission, although the lactate level had normalized, metabolic acidosis persisted. After the patient was transferred to our department, we diagnosed him with euDKA because of the history of SGLT2 inhibitor treatment. The general condition of the patient improved after continuous intravenous administration of insulin and glucose. Even in heavy alcohol drinkers with metabolic acidosis without hyperglycemia, early administration of insulin and glucose should be considered for those being treated with SGLT2 inhibitors.
