Starvation-induced true diabetic euglycemic ketoacidosis in severe depression.
True euglycemic diabetic ketoacidosis [blood glucose <200 mg/dl (11.1 mmol/l)] is relatively uncommon and in type 1 diabetes can be caused by starvation of any cause in conjunction with an intercurrent illness. We report a case of euglycemic diabetic ketoacidosis precipitated by starvation resulting from severe depression in a patient with type 1 diabetes. He was acidotic with ketonuria, but his blood glucose was only 105 mg/dl (5.8 mmol/l). He was rehydrated, the acidosis was corrected, and his depression was later treated. This case involves the complex interplay among type 1 diabetes, depression, ketoacidosis, and starvation physiology resulting in glucose concentrations in keeping with euglycemic diabetic ketoacidosis. The case also highlights that even in the absence of hyperglycemia, acid/base status should be assessed in an ill patient with diabetes, and in cases of euglycemic diabetic ketoacidosis, the diagnosis of depression should be considered as a cause for suppressed appetite and anorexia.
Joseph
Franklin
F
Diabetes Centre, Countess of Chester NHS Foundation Trust, Chester, UK.
Anderson
Lydia
L
Goenka
Niru
N
Vora
Jiten
J
D000328:Adult; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D006801:Humans; D008297:Male; D013217:Starvation / Q000150:complications* / Q000175:diagnosis / Q000523:psychology