Starvation-induced True Diabetic Euglycemic Ketoacidosis in Severe Depression

  • Franklin Joseph
  • Lydia Anderson
  • Niru Goenka
  • Jiten Vora
Case Reports/Clinical Vignettes

Abstract

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.

KEY WORDS

type 1 diabetes depression ketoacidosis starvation 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Franklin Joseph
    • 1
  • Lydia Anderson
    • 1
  • Niru Goenka
    • 1
  • Jiten Vora
    • 2
  1. 1.Diabetes CentreCountess of Chester NHS Foundation TrustChesterUK
  2. 2.Department of Diabetes and EndocrinologyRoyal Liverpool University HospitalLiverpoolUK

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