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Authors: Tasnima Tayb , Arun Raghavan

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Abstract

Background: SGLT2 inhibitors were hailed as revolutionary drugs when first approved for treatment of diabetes in an era of unprecedented cases. Introduced in 2013, the further trials of empaglifozin-remove excess glucose (EMPA-REG) in 2015 and the study of dapagliflozin in chronic kidney disease (DAPA-CK) in 2020 accelerated their use due to demonstrated cardiovascular and renal benefits, a nearly 114.6% increase between 2016 –2021. Reports started emerging soon in 2015 of a SGLT-2 inhibitor-related cause of euglycemic diabetic ketoacidosis (EDKA. Though the incidence of DKA due to SGLT-2 inhibitors is estimated to be 0.1%, they can increase the risk of DKA in T2DM by 7-fold . Of note, euglycemia was not always reported. The diagnosis of DKA is established via a triad of hyperglycemia above 250 mg/dL, ketonemia, and metabolic acidosis with elevated anion gap. EDKA, however, lacks the classic hyperglycemia element and thus can delay clinical suspicion. Life-threatening if not suspected early, EDKA has to be managed appropriately with fluids, dextrose, and insulin. Owing to the increased prevalence of SGLT2 inhibitors, the role of multidisciplinary teamwork and high suspicion can help evaluate patients with such presentations. Case Report : A 40 y.o female, known case of recurrent pancreatitis with pancreatic divisum and stricture of pancreatic duct, presented to ED with worsening abdominal pain, nausea and vomiting of one week duration. Clinically, she appeared alert and well-oriented. Her laboratory investigations revealed an elevated lipase level consistent with recurrent pancreatitis. However, reported CO2 of

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Keywords: Euglycemic Diabetic Ketoacidosis (EDKA), SGLT2 inhibitor-induced EDKA, Diabetic Ketoacidosis

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