血糖值正常之糖尿病酮酸中毒的鑑別診斷

Differential Diagnosis of Euglycemic Diabetic Ketoacidosis

臨床上病患常會以發燒、呼吸喘及心跳快等非特異性症狀來表現，需要充分了解病患過去病史、用藥史、身體診察後，才能進行鑑別診斷。骨科病房常見之非常規手術之診斷為感染，本案為一位51歲女性，以手術後傷口感染導致敗血性休克發病過程，也罕見合併血糖值正常之糖尿病酮酸中毒，除了進行相關感染症的手術和全身性抗生素治療外，血糖值正常之糖尿病酮酸中毒也在及早發現後，給予適量的靜脈注射胰島素，及輸液治療後獲得控制。因此任何不明原因代謝性酸中毒，只要有糖尿病等相關病史或服用SGLT-2抑制劑時，不論血糖值高低與否，都應懷疑有糖尿病酮酸中毒之可能。希望藉由此個案報告，提供醫療人員對於使用SGLT-2抑制劑之相關照顧經驗，及對於血糖值正常之糖尿病酮酸中毒之認識。

Patients often present with symptoms such as fever, tachypnea and tachycardia in daily practice. Many medical conditions that could be behind these symptoms. A comprehensive history taking including past history, medications and physical examination should be considered before differential diagnosis. Besides elective surgeries and examinations, the most common diagnosis in an orthopedic ward is infection. This is a 51 years-old female who suffered from postoperative wound infection, which caused septic shock, and rarely accompanied with euglycemic diabetic ketoacidosis(euDKA). The infection was treated with surgery and systemic antibiotics, and the ketoacidosis was treated with intravenous insulin and fluid resuscitation during the treatment course. Therefore, we can learn from our case that diabetic ketoacidosis should be suspected when high anion gap metabolic acidosis occurred in a diabetic patient, regardless of their blood glucose levels. Euglycemic diabetic ketoacidosis is a potentially life-threatening condition, and should not be ignored in high anion gap metabolic acidosis, especially when the patient who use the SGLT-2 inhibitor. The possibility of euglycemic diabetic ketoacidosis should be kept in mind for our medical staff in daily practice.