Postoperatory Euglycemic Diabetic Ketoacidosis: A Not So Rare Complication of Sglt2 Inhibitors

Abstract

Diabetic ketoacidosis is one of the most well-known complications of diabetes mellitus and is potentially fatal. It is characterized by a state of hyperglycemia (glycemic levels >300mg/dL), associated with metabolic ketoacidosis. It has been described that up to 3% of diabetic ketoacidosis can occur with blood glucose levels below 250 mg/dL, an incidence that has been increased since the introduction of SGLT2-i. We report the case of a female patient in her seventies, with a history of hypertension, dyslipidemia, ischemic heart disease and type 2 diabetes mellitus treated with insulin, metformin and canagliflozin. During the post-operative period of an elective surgery, she presented a decreased level of consciousness associated to metabolic acidosis. She was admitted to the ICU and required invasive mechanical ventilation and vasopressors. Euglycemic diabetic ketoacidosis was diagnosed and after treatment, she was discharged with no sequelae.