Starvation Induced Euglycaemic Diabetic Ketoacidosis in a Postoperative Diabetic Patient

Peri-operative euglycaemic diabetic ketoacidosis is under-recognized and difficult to diagnose due to variable triggers and absence of hyperglycaemia. We report a case of a 58 years old type -2 diabetic female who developed refractory post-operative metabolic acidosis caused by starvation and euglycaemic diabetic ketoacidosis. Recent surgery, major illness, carbohydrate restriction, and a relative insulin deficiency were the contributing factors leading to it. This report highlights the importance of nutrition and appropriate insulin usage in sick peri-operative diabetic patients presenting with unexplained keto acidosis.