MON-648 A Deadly Duo: Rapid-Onset Lactic Acidosis and Euglycemic DKA in a Young Male with Normal Renal Function on Metformin and Empagliflozin Resumption
Abstract
Abstract Disclosure: S.C. Macapagal: None. C.C. Park: None. K. Wirunsawanya: None. We report the first case of a young male with type 2 diabetes mellitus and normal kidney function who presented with combined lactic acidosis and euglycemic diabetic ketoacidosis (euDKA) after the resumption of metformin and empagliflozin. This is a rare presentation, with only a limited number of documented data. According to published case reports, it is typically observed in the setting of acute kidney injury, advanced age, and significant co-morbidities. A 36-year-old diabetic male with non-insulin-dependent diabetes mellitus type 2, dyslipidemia, and prior pancreatitis in 2020 who presented to the emergency department with complaints of nausea, vomiting, and abdominal pain. He had been using empagliflozin and metformin for the past six years, but discontinued both medications two months ago due to financial constraints in transportation that hindered his ability to acquire them. He had poor glycemic control reflected by his HbA1c of 12.4% due to medication non-adherence. When he had the chance to get the medications, he took the metformin 1000 mg followed by another dose in four hours (total: 2,000mg) with a one-time dose of empagliflozin 25 mg. After four hours, he woke up with nausea, vomiting, chills, confusion, and fatigue. Initial investigations showed high anion gap metabolic acidosis (bicarbonate of 10 mEq/L with a gap of 33), ketosis (beta-hydroxybutyrate > 9.00 mmol/L),…
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