SGLT2-Inhibitors and Euglycemia Diabetic Ketoacidosis: A Missed Diagnosis

Abstract

Euglycemic diabetic ketoacidosis (EuDKA), is an uncommon but potentially fatal medical emergency characterized by metabolic acidosis, ketosis, and either normal or near normal blood glucose level. The Diagnosis is delayed due to a lack of hyperglycemia leading to adverse consequences. It’s not a routine diagnosis but patients with both types of diabetes mellitus may suffer from it. Since august 2014, after the inclusion of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for the management of diabetes mellitus, the incidence of euglycemia DKA has raised. The other conditions that may contribute to this metabolic disorder include fasting, chronic liver disease, pregnancy, gastroparesis, bariatric surgery, glycogen storage disease, cocaine intoxication, and insulin pump failure. Euglycemic DKA, a diagnosis of exclusion, should be considered in any unexplained metabolic acidosis among diabetic patients, who report to the hospital with nonspecific symptoms not suggesting DKA and have been taking sodium-glucose cotransporter-2 inhibitors. Here we are describing a case of ketoacidosis with normoglycemia caused by empagliflozin in a female suffering from type 2 diabetes mellitus to raise awareness of physicians to minimize the delays in the identification of this life-threatening metabolic disorder.