Euglycemic Diabetic Ketoacidosis, diagnostic challenge in resource limited countries: Case series

Euglycemic diabetic ketoacidosis (Euglycemic DKA) can present with diagnostic difficulty in resource limited countries because of absence of hyperglycemia which is a key feature in diagnosis of DKA. Diagnosis can be delayed or even missed entirely with detrimental consequences in resource limited countries because of poor health infrastructure including lack of laboratory support. We describe two children with type 1 diabetes mellitus (T1DM) who presented with infections and euglycemic DKA. One presented with severe malaria and the other with cerebral malaria and urinary tract infection. Both patients were found to have normoglycemia and ketonuria with clinical signs of metabolic acidosis which eventually led to diagnosis of euglycemic DKA for which they were successfully managed. Our account emphasized the need for testing blood glucose as well as urine ketones in critically ill children and adolescents with infections especially if they have been diagnosed with diabetes mellitus. Because the clinical features of euglycemic DKA are similar to those of infections which are rather more common in Ghana and Africa.