Empagliflozin-Induced Nondiabetic Ketoacidosis in Advanced Alcoholic Liver Disease
Abstract
A 67-year-old man with advanced alcoholic-associated liver disease developed nondiabetic ketoacidosis shortly after starting empagliflozin for congestive heart failure. He presented with high anion-gap metabolic acidosis, elevated beta-hydroxybutyrate levels, and hypoglycemia. The condition resolved promptly after empagliflozin discontinuation and initiation of intravenous fluids, thiamine, and dextrose therapy. This case highlights the risk of early-onset ketoacidosis in patients with cirrhosis and alcohol use treated with sodium-glucose cotransporter-2 inhibitors, emphasizing careful patient selection and vigilant early monitoring of electrolytes and renal function. As the application of sodium-glucose cotransporter-2 inhibitors expands into managing refractory ascites in cirrhotic patients, further studies are required to confirm their safety.
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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.
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