Early-Onset Euglycemic Diabetic Ketoacidosis Following Empagliflozin Initiation Triggered by Acute Influenza and a Ketogenic Diet
Abstract
Euglycemic diabetic ketoacidosis (euDKA) is a form of diabetic ketoacidosis in which severe ketosis and acidemia occur despite mild hyperglycemia, leading to delayed diagnosis. EuDKA incidence has increased with widespread sodium-glucose cotransporter-2 inhibitor (SGLT2i) use, particularly during acute illness. While most reported cases occur after prolonged SGLT2i exposure, early-onset euDKA shortly after initiation remains rare. This case illustrates euDKA occurring within 48-72 hours of empagliflozin initiation in the setting of influenza A infection and a ketogenic diet, highlighting multifactorial euDKA pathogenesis and the need to reassess diabetes phenotype when insulin requirements are unexpectedly low. A 52-year-old female with type 2 diabetes mellitus presented with three days of flu-like symptoms, nausea, vomiting, dizziness, and poor oral intake. She initiated a ketogenic diet and empagliflozin 72 hours prior. Laboratory evaluation indicated high-anion-gap metabolic acidosis with a venous pH of 7.03, bicarbonate of 5 mmol/L, anion gap of 29, β-hydroxybutyrate of 7.0 mmol/L, and hyperglycemia (blood glucose 238 mg/dL). HbA1c was 10.6% (11.8% one month prior). She was admitted to the ICU and treated with fluids, insulin, and electrolyte monitoring. Despite severe acidemia, insulin requirements were minimal, totaling approximately 13.5 units, and she was transitioned to 5 units of glargine daily. Evaluation for autoimmune diabetes demonstrated preserved C-peptide…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- The Role of AMPK Activation for Cardioprotection in Doxorubicin-Induced Cardiotoxicity
- Hypoglycemic medicines in the treatment of Alzheimer’s disease: Pathophysiological links between AD and glucose metabolism
- Isorhamnetin Reduces Glucose Level, Inflammation, and Oxidative Stress in High-Fat Diet/Streptozotocin Diabetic Mice Model
- Modulating Sirtuin Biology and Nicotinamide Adenine Diphosphate Metabolism in Cardiovascular Disease—From Bench to Bedside
- Characterization of the SGLT2 Interaction Network and Its Regulation by SGLT2 Inhibitors: A Bioinformatic Analysis
- Early Treatment with Empagliflozin and GABA Improves β-Cell Mass and Glucose Tolerance in Streptozotocin-Treated Mice
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.