Euglycemic Ketoacidosis in a Patient with Prolonged Malnutrition Syndrome

We present the case of a 53-year-old woman admitted to the emergency department for vomiting and abdominal pain, ultimately diagnosed with euglycemic ketoacidosis. The patient had a history of severe malnutrition associated with depressive disorder, with almost exclusive fruit intake for at least 2 months. Evaluation revealed high anion gap metabolic acidosis, significant ketonemia, but normal blood glucose levels. Exogenous intoxication and diabetes mellitus were excluded. Fluid resuscitation and bicarbonate led to clinical and laboratory improvement. This case highlights the importance of considering malnutrition as a cause of ketosis and metabolic acidosis.