Euglycaemic diabetic ketoacidosis in a patient with pancreatitis and type 2 diabetes on empagliflozin

Abstract

Sodium glucose cotransporter-2 (SGLT2) inhibitors are glucose-lowering drugs with proven efficacy in treating type 2 diabetes mellitus, and more recently, have been shown to improve heart failure outcomes in patients without diabetes. A rare complication of SGLT2 inhibitor use is the development of euglycaemic diabetic ketoacidosis (EDKA), characterised by euglycaemia (blood glucose level <250 mg/dL), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L), and ketonaemia. Given patients with EDKA do not present with the typical manifestations of diabetic ketoacidosis, including marked hyperglycaemia and dehydration, the diagnosis of EDKA may be missed and initiation of treatment delayed. We present the case of a man with recent SGLT2 inhibitor use and multiple other risk factors who developed EDKA.

Empagliflozin induces apoptotic-signaling pathway in embryonic vasculature: In vivo and in silico approaches via chick’s yolk sac membrane model

“…The natriuretic and diuretic effects of EMP can also exacerbate volume depletion and enhance the risk of hypotension, especially among people with renal failure and the elderly. Recently, there has been increasing concern in the literature about an increased risk of diabetic ketoacidosis, pancreatitis and bone disorders associated with SGLT2 inhibitors (including EMP) ( Perkins et al, 2014 ; Frampton, 2018 ; Sampani et al, 2020 ; Dziadkowiec et al, 2021 ; Bardhi et al, 2022 ).…”