Objective: Euglycemic diabetic ketoacidosis (DKA) is a known potential complication from sodium-glucose cotransporter 2 (SGLT2) inhibitor use. We present a unique case presentation of a 44-year-old, male patient on an SGLT2 inhibitor who developed euglycemic DKA while following a carbohydrate-restricted diet, the Atkins diet. Methods: The patient was on sitagliptin and metformin after a hemoglobin A1c result of 9.3% (78 mmol/mol). Motivated to obtain better glycemic control and weight loss, he started on the Atkins diet, but stayed in the carbohydrate-restricted first phase of the diet. Canagliflozin was added to his regimen 1 month later. Three to four days after starting on the medication, he developed severe abdominal pain. Results: The patient was found to have anion gap metabolic acidosis with an elevated beta-hydroxybutyrate level of 75.50 mg/dL (the reference range is 0.20 to 2.80 mg/dL) and a blood glucose value of 180 mg/dL. Conclusion: The low-carbohydrate diet likely predisposed our patient to a ketogenic metabolic state and the addition of canagliflozin likely precipitated the worsening of his ketosis and subsequent DKA. For patients taking SGLT2 inhibitors, carbohydrate-restricted diet plans may increase the risk of developing euglycemic DKA.

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No published case of Wolman's disease has described the prenatal sonographic findings. We present a case in which a third-trimester sonographic examination demonstrated fetal hepatomegaly and bilateral adrenal echogenicity suggestive of diffuse calcification. Wolman's disease, also known as lysosomal acid lipase (LIPA) deficiency, is a rare autosomalrecessive disorder characterized by complete absence of the LIPA enzyme. The diagnosis of Wolman's disease was made postnatally by biochemical testing, which indicated absence of LIPA enzyme activity and gene sequencing, which confirmed homozygosity for the G66V mutation within the LIPA gene. V C 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:66-68, 2018; Published online in Wiley Online Library (wileyonlinelibrary.com).

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