Euglycemic Ketoacidosis in a Patient with Prolonged Malnutrition Syndrome
Euglycemic Ketoacidosis and Malnutrition
Abstract views: 69
/ 
PDF downloads: 27
DOI:
https://doi.org/10.5281/zenodo.17447597Keywords:
Diabetic Ketoacidosis, Ketosis, Malnutrition, Acidosis, Metabolic, Malnutrition/complications, AnorexiaAbstract
We present the case of a 53-year-old woman admitted to the emergency department for vomiting and abdominal pain, ultimately diagnosed with euglycemic ketoacidosis. The patient had a history of severe malnutrition associated with depressive disorder, with almost exclusive fruit intake for at least 2 months. Evaluation revealed high anion gap metabolic acidosis, significant ketonemia, but normal blood glucose levels. Exogenous intoxication and diabetes mellitus were excluded. Fluid resuscitation and bicarbonate led to clinical and laboratory improvement. This case highlights the importance of considering malnutrition as a cause of ketosis and metabolic acidosis.
References
Modi A, Agrawal A, Morgan F. Euglycemic Diabetic Ketoacidosis: A Review. Curr Diabetes Rev. 2017;13(3):315-321. doi:10.2174/1573399812666160421121307
Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium-Glucose Cotransporter 2 Inhibition. Diabetes Care. 2015;38(9):1687-1693. doi:10.2337/dc15-0843
Rice M, Ismail B, Pillow MT. Approach to metabolic acidosis in the emergency department. Emerg Med Clin North Am. 2014;32(2):403-420. doi:10.1016/j.emc.2014.01.002
Frise CJ, Mackillop L, Joash K, Williamson C. Starvation ketoacidosis in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2013;167(1):1-7. doi:10.1016/j.ejogrb.2012.10.005
Seheult J, Fitzpatrick G, Boran G. Lactic acidosis: an update. Clin Chem Lab Med. 2017;55(3):322-333. doi:10.1515/cclm-2016-0438
Methanol Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Feb 6. Accessed May 2025.
Kraut JA, Madias NE. Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol. 2007;2(1):162-174. doi:10.2215/CJN.03020906
Brar PC, Tell S, Mehta S, Franklin B. Hyperosmolar diabetic ketoacidosis-- review of literature and the shifting paradigm in evaluation and management. Diabetes Metab Syndr. 2021;15(6):102313. doi:10.1016/j.dsx.2021.102313
Marinella MA. Refeeding syndrome: an important aspect of supportive oncology. J Support Oncol. 2009;7(1):11-16.
Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495-1498. doi:10.1136/bmj.a301
National Institute for Health and Care Excellence. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical guideline [CG32]. 2006.
Rio A, Whelan K, Goff L, Reidlinger DP, Smeeton N. Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. BMJ Open. 2013;3(1):e002173. Published 2013 Jan 11. doi:10.1136/bmjopen-2012-002173
Treasure J, Schmidt U. The role of the psychiatrist in eating‐disorder management. Br J Psychiatry. 2013;202(5):329-331.
Downloads
Published
How to Cite
License
Copyright (c) 2025 Luís Veiga, Anita Campos, Maria Eduarda Martins
This work is licensed under a Creative Commons Attribution 4.0 International License.
The journal is licensed under a 