Starvation-induced true diabetic euglycemic ketoacidosis in severe depression

J Gen Intern Med. 2009 Jan;24(1):129-31. doi: 10.1007/s11606-008-0829-0. Epub 2008 Oct 31.

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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Depressive Disorder / complications*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / psychology
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetic Ketoacidosis / diagnosis
  • Diabetic Ketoacidosis / etiology*
  • Diabetic Ketoacidosis / psychology
  • Humans
  • Male
  • Starvation / complications*
  • Starvation / diagnosis
  • Starvation / psychology