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Case Reports in Critical Care
Volume 2016, Article ID 4275651, 4 pages
http://dx.doi.org/10.1155/2016/4275651
Case Report

Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication

1Jordan University for Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
2Department of Medicine, Dow Medical College, Baba-E-Urdu Road, Karachi 74200, Pakistan
3Section of Pulmonary & Critical Care Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA

Received 13 June 2016; Revised 11 July 2016; Accepted 12 July 2016

Academic Editor: Moritoki Egi

Copyright © 2016 Asma Abu-Abed Abdin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.