Euglycemic diabetic ketosis detected as false-positive on alcohol breath test by taking SGLT 2 inhibitor: A case report

Abstract

We herein report a 57-year-old taxi driver with type 2 diabetes on canagliflozin, a sodium glucose cotransporter 2 inhibitor, who presented to our outpatient clinic with a positive alcohol breath test over the previous 3 days. Two weeks earlier, he had been admitted to our hospital for the improvement of glycemic control. On admission, his body mass index was 33 kg/m2, hemoglobin A1c was 9.1 %, and anti-glutamic acid decarboxy-lase antibody was negative. His dietary energy intake was restricted to 22 kcal/kg of ideal body weight, and canagliflozin was continued. One day after his discharge, an alcohol breath test registered as positive before driving, and he was not allowed to work despite not having drunk any alcohol. Laboratory tests revealed nor-moglycemia (113 mg/dL) and ketonuria without metabolic acidosis, indicating a diagnosis of euglycemic ketosis due to canagliflozin combined with dietary energy restriction. Alcohol was not detected in his blood. We instructed him to stop taking canagliflozin and increase his dietary carbohydrate intake. Three days later, the alcohol breath test became negative, and we confirmed negative ketonuria. In patients with diabetes, a positive alcohol breath test may allow for the early detection of ketosis, but false-positive results can cause social problems, especially for drivers. Physicians should bear in mind that simple alcohol breath tests detect acetone.