PMID- 35911365
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220802
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 6
DP  - 2022 Jun
TI  - SGLT-2 Inhibitor-Associated Euglycemic Diabetic Ketoacidosis: A Case Report and a 
      Literature Review.
PG  - e26267
LID - 10.7759/cureus.26267 [doi]
LID - e26267
AB  - Diabetic ketoacidosis (DKA) is considered a medical emergency, most commonly 
      associated with type 1 diabetes mellitus, and is relatively rare in type 2 
      diabetes mellitus (T2DM). We discuss a case of a 45-year-old woman with T2DM who 
      presented to the emergency room with worsening lethargy and weakness. Before her 
      presentation, her physician had recently added empagliflozin, a sodium-glucose 
      cotransporter-2 (SGLT-2) inhibitor, to her anti-diabetic drug regimen along with 
      glimepiride and a combination drug of vildagliptin and metformin. Based on the 
      clinical examination and lab findings, DKA was suspected, but her glucose level 
      was below the cutoff value for DKA diagnosis. However, her lab results showed 
      significant metabolic acidosis and ketonemia with no clinical or laboratory 
      features of sepsis. Therefore, the diagnosis of euglycemic diabetic ketoacidosis 
      (eu-DKA) was made. She was successfully treated according to the DKA protocol and 
      discharged in good condition. In this report, our aim is to discuss the 
      relationship between SGLT-2 inhibitors with eu-DKA. Given the absence of 
      significant hyperglycemia, recognition of this entity by clinicians may be 
      delayed. Serum ketones should be obtained in diabetic patients with symptoms of 
      nausea, vomiting, or malaise while taking SGLT-2 inhibitors, and SGLT-2 
      inhibitors should be discontinued if ketoacidosis is confirmed.
CI  - Copyright (c) 2022, Mahfooz et al.
FAU - Mahfooz, Rabia Salman
AU  - Mahfooz RS
AD  - Internal Medicine, Shalamar Institute of Health Sciences, Lahore, PAK.
FAU - Khan, Muhammad Khuzzaim
AU  - Khan MK
AD  - College of Medicine, Dow University of Health Sciences, Civil Hospital Karachi, 
      Karachi, PAK.
FAU - Al Hennawi, Hussam
AU  - Al Hennawi H
AD  - Internal Medicine, Jefferson Abington Hospital, Abington, USA.
FAU - Khedr, Anwar
AU  - Khedr A
AD  - Internal Medicine, BronxCare Health System, New York, USA.
LA  - eng
PT  - Case Reports
DEP - 20220623
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9313009
OTO - NOTNLM
OT  - : diabetes mellitus
OT  - diabetes mellitus type 2
OT  - empagliflozin
OT  - euglycemic diabetic ketoacidosis
OT  - sodium-glucose cotransporter-2 (sglt-2) inhibitors
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/08/02 06:00
MHDA- 2022/08/02 06:01
PMCR- 2022/06/23
CRDT- 2022/08/01 03:45
PHST- 2022/06/23 00:00 [accepted]
PHST- 2022/08/01 03:45 [entrez]
PHST- 2022/08/02 06:00 [pubmed]
PHST- 2022/08/02 06:01 [medline]
PHST- 2022/06/23 00:00 [pmc-release]
AID - 10.7759/cureus.26267 [doi]
PST - epublish
SO  - Cureus. 2022 Jun 23;14(6):e26267. doi: 10.7759/cureus.26267. eCollection 2022 
      Jun.