Euglycemic Diabetic Ketoacidosis Induced by Sodium-glucose Cotransporter-2 Inhibitor in the Setting of Chronic Kidney Disease with Dehydration Induced by Nausea and Vomiting: A Case Report
Abstract
Background: Euglycemic diabetic ketoacidosis (EDKA) is a recognized but uncommon adverse effect of sodium–glucose cotransporter-2 (SGLT2) inhibitors. It presents with metabolic acidosis and significant ketosis, yet with normal or near-normal blood glucose levels, making its diagnosis frequently delayed. SGLT2 inhibitors are increasingly used for their cardiovascular and renal benefits in patients with type 2 diabetes mellitus; however, clinicians should remain alert to this potential complication, especially when additional risk factors such as dehydration, fasting, or renal impairment coexist.
Case presentation: We report the case of a 54-year-old male with long-standing type 2 diabetes mellitus, hypertension, and chronic kidney disease who developed euglycemic diabetic ketoacidosis following two days of nausea, vomiting, and poor oral intake. The patient had been on empagliflozin and pioglitazone therapy. On admission, he appeared dehydrated and mildly tachycardic. Laboratory findings revealed metabolic acidosis (pH 7.10, bicarbonate 15 mmol/L, with an elevated anion gap), positive serum ketones, and a normal blood glucose level of 9 mmol/L. After exclusion of other causes, the diagnosis of EDKA secondary to SGLT2 inhibitor use was established. Empagliflozin was discontinued, and the patient was treated with dextrose-containing intravenous fluids, continuous insulin infusion, and electrolyte replacement. His metabolic derangements resolved within 48 hours, and he was…
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