Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor

Background. Sodium glucose cotransporter-2 (SGLT2) inhibitors have been proven to be very effective in the management of type II diabetes. These medications can cause adverse drug reactions such as genital mycotic infections. Another critical adverse drug reaction is euglycemic diabetic ketoacidosis...

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Main Authors: Mohamed Alhemeiri, Eiman Alseddeeqi
Format: Article
Language:English
Published: Wiley 2022-01-01
Series:Case Reports in Endocrinology
Online Access:http://dx.doi.org/10.1155/2022/4101975
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author Mohamed Alhemeiri
Eiman Alseddeeqi
author_facet Mohamed Alhemeiri
Eiman Alseddeeqi
author_sort Mohamed Alhemeiri
collection DOAJ
description Background. Sodium glucose cotransporter-2 (SGLT2) inhibitors have been proven to be very effective in the management of type II diabetes. These medications can cause adverse drug reactions such as genital mycotic infections. Another critical adverse drug reaction is euglycemic diabetic ketoacidosis (EDKA) under the setting of other contributing risk factors for developing diabetic ketoacidosis. Case Presentation. We report a case of a 45-year-old gentleman with type 2 diabetes mellitus on empagliflozin, metformin, and glimepiride who presented with abdominal pain, fatigue, and vomiting. Of note, he started a ketogenic diet three days before his presentation and self-stopped his antidiabetic medications two days before his presentation. The patient was found to have euglycemic diabetic ketoacidosis and was treated as per the protocol. He was discharged on metformin and pioglitazone. Two weeks following discharge, canagliflozin was added. Conclusion. Euglycemic diabetic ketoacidosis could still be precipitated despite discontinuation of SGLT2I under a ketogenic diet. Discussion related to the initiation of a ketogenic diet should occur between the care provider and the patient.
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spelling doaj-art-db94df5fd5034945a7a5cfb6c1966b272025-08-20T02:21:17ZengWileyCase Reports in Endocrinology2090-651X2022-01-01202210.1155/2022/4101975Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 InhibitorMohamed Alhemeiri0Eiman Alseddeeqi1Medical Education DepartmentDivision of EndocrinologyBackground. Sodium glucose cotransporter-2 (SGLT2) inhibitors have been proven to be very effective in the management of type II diabetes. These medications can cause adverse drug reactions such as genital mycotic infections. Another critical adverse drug reaction is euglycemic diabetic ketoacidosis (EDKA) under the setting of other contributing risk factors for developing diabetic ketoacidosis. Case Presentation. We report a case of a 45-year-old gentleman with type 2 diabetes mellitus on empagliflozin, metformin, and glimepiride who presented with abdominal pain, fatigue, and vomiting. Of note, he started a ketogenic diet three days before his presentation and self-stopped his antidiabetic medications two days before his presentation. The patient was found to have euglycemic diabetic ketoacidosis and was treated as per the protocol. He was discharged on metformin and pioglitazone. Two weeks following discharge, canagliflozin was added. Conclusion. Euglycemic diabetic ketoacidosis could still be precipitated despite discontinuation of SGLT2I under a ketogenic diet. Discussion related to the initiation of a ketogenic diet should occur between the care provider and the patient.http://dx.doi.org/10.1155/2022/4101975
spellingShingle Mohamed Alhemeiri
Eiman Alseddeeqi
Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor
Case Reports in Endocrinology
title Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor
title_full Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor
title_fullStr Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor
title_full_unstemmed Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor
title_short Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor
title_sort euglycemic diabetic ketoacidosis after discontinuing sglt2 inhibitor
url http://dx.doi.org/10.1155/2022/4101975
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AT eimanalseddeeqi euglycemicdiabeticketoacidosisafterdiscontinuingsglt2inhibitor