Empagliflozin-Associated Acidoketosis: A Sneaky Friend
Abstract
High anion gap (HAG) metabolic acidosis is nowadays one of the most common acid-base disorders in the critical care unit (ICU). Early investigation of possible aetiologies is crucial to treatment in order to avoid potentially fatal outcomes. Among these, diabetic ketoacidosis (DKA) is unlikely to be missed in the context of a clear history of diabetes and/or pathognomonic laboratory values (elevated blood glucose, hyperlactatemia, ketonuria). Nevertheless, in rare cases, patients may present with HAG metabolic acidosis with normal or slightly above-normal blood glucose levels, as in those taking sodium-glucose cotransporter 2 (SGLT2) medications, making it easy to overlook by physicians, and potentially life-threatening. In this report, we present an infrequent case of severe metabolic acidosis associated with empagliflozin and the significant role of early and appropriate management with a view of the literature
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