SHM Converge Scientific Abstract ePoster Gallery-Unmasking Edka: Pregnancy, Sepsis, and GLP-1 Analog Interplay

Pdf Summary

This case report describes a 35-year-old pregnant woman with type 2 diabetes who developed euglycemic diabetic ketoacidosis (EDKA) in the setting of acute infection and missed insulin doses. She presented with chills, worsening left shoulder pain, and reduced range of motion after recent shoulder injections. Imaging showed diffuse cellulitis, myositis, and a small glenohumeral effusion, and she met sepsis criteria. She underwent arthroscopic irrigation and debridement, and wound cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). She was initially treated with vancomycin and ceftriaxone, then switched to cefazolin after culture results and infectious disease consultation.<br /><br />During hospitalization, she developed high anion gap metabolic acidosis with ketonemia but only modest hyperglycemia (glucose 250 mg/dL), consistent with EDKA. Contributing factors included pregnancy, sepsis, and non-adherence to insulin; she had been taking dulaglutide, a GLP-1 receptor agonist. She was admitted to the ICU, treated with an insulin drip and IV fluids, and closely monitored until the anion gap closed. She was then transitioned to subcutaneous insulin (glargine and lispro) and continued to improve.<br /><br />The report emphasizes that EDKA is a dangerous but often missed diagnosis because significant hyperglycemia may be absent. While SGLT2 inhibitors are well known to trigger EDKA, the role of GLP-1 receptor agonists remains uncertain. The authors stress the importance of maintaining a high index of suspicion for EDKA in pregnant patients and in those with infection or insulin noncompliance, regardless of glucose level. Patient education, insulin adherence, and careful monitoring are highlighted as key to prevention and management.

Asset Subtitle

Alice Huang

Meta Tag

Author List Alice Huang, Gagandeep S. Sekhon, Isabel M. Gosen, Jenny Lu, July M. Reyes, Nicole Pancotto, Roxana Lazarescu

Category Clinical Vignettes

Concept Euglycemic Diabetic Ketoacidosis

Concept Metabolic Acidosis

Concept Ketonemia

Concept Insulin Infusion

Concept Intravenous Fluids

Distinguished Non-Finalist

Presenter Organization Touro College of Osteopathic Medicine - Harlem

Presenting Author Alice Huang

Track Adult

Keywords

euglycemic diabetic ketoacidosis

pregnancy

type 2 diabetes

sepsis

methicillin-sensitive Staphylococcus aureus

insulin nonadherence

glucagon-like peptide-1 receptor agonist

cellulitis

myositis

insulin drip

Euglycemic Diabetic Ketoacidosis

Metabolic Acidosis

Ketonemia

Insulin Infusion

Intravenous Fluids