Endocrine Abstracts

Non-diabetic euglycaemic ketoacidosis (NDEK) is a rare condition defined as euglycaemia, metabolic acidosis and elevated serum ketones occurring in patients without diabetes mellitus. It is less well known compared to diabetic ketoacidosis (DKA) and euglycaemic diabetic ketoacidosis (EDKA), both happening in patients with diabetes. Here we describe a case of a 35-year old woman, previously fit and well, who presented with unidentified cause of pancreatitis leading to severe metabolic acidosis. Despite the conventional medical treatment for pancreatitis, she was still in resistant metabolic acidosis status. Intensive care input was sought and she was taken there for further management. In view of unexplained and ongoing metabolic acidosis, a finger prick point of care capillary blood ketone reading was found to be elevated at 4.7mmol/l despite being normoglycaemic in the last 23 h post-admission. Urgent Diabetologist input was requested. A diagnosis of NDEK was made. Blood glucose throughout admission remained below 10mmol/l. Serum Beta-Hydroxybutyrate level was analysed retrospectively on her admission blood sample which confirmed elevation at 8.03mmol/l. Glycated haemoglobin level was normal at 37mmol/l. She was started on fixed rate insulin infusion with intravenous dextrose fluid therapy and later stepped down to variable rate insulin infusion. Within a few hours of starting intravenous insulin, point of care blood ketones had significantly reduced with normalisation of serum bicarbonate. Due to low awareness of NDEK, there was delay in serum ketones checking, right diagnosis and implementation of correct treatment plans until the involvement of a Diabetologist. Given the complexity of the presentation, metabolic management and potential complications associated with delayed diagnosis and correct care plan, we propose early involvement of Diabetologist in all NDEK cases. This case also serves as another learning example of challenging NDEK presentation and to raise more awareness amongst clinicians of this condition.