Case Report: Early-onset euglycemic diabetic ketoacidosis following henagliflozin initiation in a treatment-naive patient
Abstract
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with euglycemic diabetic ketoacidosis (euDKA), typically occurring after ≥2 weeks of therapy in the setting of intercurrent illness or surgical stress. The risk of early-onset euDKA in treatment-naive patients-those without prior glucose-lowering therapy or established metabolic stability-remains poorly characterized. We describe a case of severe euDKA occurring within 4 days of SGLT2 inhibitor initiation, precipitated solely by metformin-induced gastrointestinal adverse effects.
Case presentation: A 40-year-old woman with newly diagnosed type 2 diabetes (HbA1c 12.9%) was initiated on metformin, henagliflozin (SGLT2 inhibitor), and chiglitazar. Within 24 hours, she developed nausea and vomiting attributed to metformin intolerance. Despite progressive symptoms and minimal oral intake over 72 hours, she continued all medications without seeking medical care. On day 4, she presented with severe high-anion-gap metabolic acidosis (pH 7.043, bicarbonate 6.5 mmol/L), ketonemia (β-hydroxybutyrate 5.6 mmol/L), and plasma glucose 8.5 mmol/L-consistent with euDKA. Management included intravenous dextrose, insulin infusion, and fluid resuscitation, with resolution by day 3. The patient was discharged on basal insulin, metformin, and chiglitazar (SGLT2 inhibitor discontinued), with no recurrence at 4-week follow-up.
Conclusion: In treatment-naive patients initiating SGLT2 inhibitor-based combination therapy,…
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
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
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.