Euglycemic diabetic ketoacidosis in the setting of SGLT2 inhibitor use

Abstract EN

Diabetic ketoacidosis (DKA) is a medical emergency as acute complication of diabetes mellitus, characterized by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L), and with an increased anion gap and the presence of ketone bodies in the blood and/or urine.1 Rarely, patients can present with blood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA (euDKA).

There is an established, though rare, association of DKA with normal glucose values or euDKA with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors).2,3Euglycemic DKA (euDKA), is classically considered rare, but this is perhaps a result of underrecognition and underreporting.4 We present here a clinical case of euDKA associated with the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors in a Syrian patient.