Les acidocétoses diabétiques atypiques

Hyperglycemia is a key diagnosis of diabetic ketoacidosis, one of the most serious complication of type 1 diabetes (T1D) occurring in case of absolute or relative insulin deprivation. However, there are atypical forms of ketoacidosis mainly characterized by mild to moderate glucose elevation or in situation without insulin deprivation. Such an atypical ketoacidosis can occur in T1D in the presence of adequate hydration and a degree of insulin intake. Such euglycemic ketoacidosis was recently described in patients with T1D or, more often, with type 2 diabetes (T2D) during a treatment by gliflozins, SGLT2 cotransporter inhibitors, which lower glucose by enhancing its excretion by blocking reabsorption in the renal tubules. Ketoacidosis also can occur in patients with an authentic T2D, named « ketosis-prone diabetes », combining a decreased carbohydrate intake, an adequate hydration, and a relative and transient insulinopenia. Alcoholic ketoacidosis is another cause of euglycemic ketoacidosis in people with diabetes. An atypical ketoacidosis was also described in patients treated by atypical antipsychotic drugs. The recognition of these forms of ketoacidosis may be difficult and may lead to disastrous consequences while ketoacidosis is always a medical emergency that needs to be treated urgently.