Topic- Euglycemic Diabetic Ketoacidosis in a Patient of Type 2 DM on Alternative Medicine Precipitated by Dengue Infection

Aim: Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus (DM) that can become life-threatening. DKA is recognized by hyperglycemia, metabolic acidosis and presence of serum and/or urine ketones. DKA can occur in the setting of normal glucose concentrations. This uncommon form of DKA is known as euglycemic DKA. The aim of this case report is to alert the physician to include euglycemic DKA in differential diagnosis for a patient presenting with dengue fever and metabolic ketoacidosis with a past history of diabetes on alternative medicine therapy.

Presentation of Case: A 70-year-old female presented to us with high grade (102 deg F), intermittent type fever for 3 days. She also reported nausea, vomiting and bilateral knee joint pain. She reported having diabetes for the last 10 years for treatment of which she was on alternative therapy medication. Laboratory workup showed dengue fever, severe metabolic acidosis and 3+ ketonuria. RBS was 186 mg/dl. She was treated with IV fluids for hydration, paracetamol (antipyretics), regular insulin and dextrose drip. Her health improved with the above-mentioned treatment.

Discussion: Euglycemic DKA is defined as DKA with BG concentration of <200 mg/d. DKA can go undiagnosed if the patient has blood sugar levels of <200 mg/dl at the time of initial presentation. Moreover, DKA occurs rarely in a patient presenting with dengue fever.

Conclusion: Euglycemic DKA is a rare presntation of DKA and thus can go undiagnosed at initial presentation. It may be seen in patients with diabetes (on alternative therapy medications) presenting with dengue fever.