Case report of empagliflozin-induced euglycemic diabetic ketoacidosis

Abstract

Diabetic ketoacidosis (DKA) is a common metabolic emergency in diabetic patients encountered by emergency departments (EDs). Euglycemic diabetic ketoacidosis (EDKA) is a rare type of DKA characterized by normal to slightly elevated blood glucose levels. Possible causes of EDKA include fasting, pregnancy, and alcohol consumption. In this report, we are presenting a case of EDKA associated with the use of empagliflozin, an oral antihyperglycemic medication belonging to the sodium-glucose co-transporter 2 inhibitors (SGLT-2). The case is a 43-year-old diabetic male patient, who presented to the ED complaining of nausea, vomiting, and generalized weakness. Upon history taking, it was found that the patient started taking empagliflozin 10 days ago. Accordingly, appropriate diagnostic tests were requested, and the patient was found to have severe DKA despite normal to slightly elevated blood glucose results. A diagnosis of EDKA was confirmed, and the patient was successfully treated and discharged few days later. Many reports have linked the use of SGLT-2 inhibitors with an increased risk of developing DKA, especially EDKA. Although the management of DKA and EDKA is similar, it is more challenging to diagnose the latter. We have highlighted these challenges and the most common precipitating factors. Additionally, we highlighted the mechanism for developing EDKA and the appropriate diagnostic approach to follow with diabetic patients using SGLT-2 inhibitors.