Euglycemic Diabetic Ketoacidosis in a Type II Diabetic Patient Treated with Empagliflozin

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a new class of oral drugs used to treat type 2 diabetes (T2DM). EuGlycemic Diabetic Ketoacidosis (EuDKA) is associated with an almost normal level of blood glucose, causing a delay in its diagnosis and treatment. The diagnosis of EuDKA is a challenge for doctors due to its unusual manifestations. EuDKA is one of the rare complications associated with the use of SGLT-2 inhibitors, but it is serious and dangerous. Early diagnosis and treatment of EuDKA require the knowledge and precision of doctors so that they can quickly and safely restore the acid-base balance. EuDKA appears with a slight increase in blood glucose (less than the level defined in the diagnostic criteria for DKA), metabolic acidosis, and increase in the anion gap. Its manifestations are somewhat different from typical DKA. Patients with type 1 or 2 diabetes who present weakness, nausea and vomiting, and metabolic acidosis and are taking SGLT-2 inhibitors should be evaluated for the presence of urine and/or serum ketones. In this report, we reported a case of euglycemic DKA following the use of SGLT2 inhibitor and its treatment.