title: Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication.
abstract: Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as "euglycemic DKA." This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA.
authors: Jordan University for Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
authors: Asma
authors: A
authors: Abu-Abed Abdin
authors: Department of Medicine, Dow Medical College, Baba-E-Urdu Road, Karachi 74200, Pakistan.
authors: Muhammad
authors: 0000-0003-1445-3986
authors: M
authors: Hamza
authors: Section of Pulmonary & Critical Care Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA.
authors: Muhammad S
authors: 0000-0001-9969-4222
authors: MS
authors: Khan
authors: Section of Pulmonary & Critical Care Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA.
authors: Awab
authors: A
authors: Ahmed