Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report
Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i), like empagliflozin, are widely prescribed for managing type 2 diabetes mellitus. However, they carry a rare but serious risk: euglycemic diabetic ketoacidosis (EDKA). EDKA’s atypical presentation, characterized by metabolic aci...
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| Format: | Article |
| Language: | English |
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BMC
2025-08-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-025-00963-8 |
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| author | Ophélie Dirand Julie Dupont Emmanuel Weiss Myriam Lamamri |
| author_facet | Ophélie Dirand Julie Dupont Emmanuel Weiss Myriam Lamamri |
| author_sort | Ophélie Dirand |
| collection | DOAJ |
| description | Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i), like empagliflozin, are widely prescribed for managing type 2 diabetes mellitus. However, they carry a rare but serious risk: euglycemic diabetic ketoacidosis (EDKA). EDKA’s atypical presentation, characterized by metabolic acidosis and ketosis despite normal blood glucose levels, often delays diagnosis, posing significant challenges in intensive care. Case presentation We report the case of a 74-year-old female with type 2 diabetes on empagliflozin, gliclazide, and metformin. Admitted after severe trauma from a road traffic accident, she subsequently developed EDKA. This was fostered by septic shock due to methicillin-susceptible Staphylococcus aureus cellulitis. All home medications were discontinued. EDKA was successfully managed with fluid volume expansion, continuous intravenous insulin and dextrose infusions, resolving her metabolic derangements within five days. Conclusion SGLT2i use is associated with a significantly increased risk of EDKA. Early diagnosis is critical due to its potential lethal consequences. Reintroducing SGLT2i in ICU patients, especially trauma patients at high sepsis risk, requires careful, daily reassessment given their unpredictable clinical course. |
| format | Article |
| id | doaj-art-e367e802eac04ba6aff0b857e02ac428 |
| institution | Kabale University |
| issn | 1865-1380 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj-art-e367e802eac04ba6aff0b857e02ac4282025-08-20T03:42:23ZengBMCInternational Journal of Emergency Medicine1865-13802025-08-011811510.1186/s12245-025-00963-8Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case reportOphélie Dirand0Julie Dupont1Emmanuel Weiss2Myriam Lamamri3Département d’anesthésie réanimation, AP-HP, Hôpital Beaujon, DMU PARABOLDépartement d’anesthésie réanimation, AP-HP, Hôpital Beaujon, DMU PARABOLDépartement d’anesthésie réanimation, AP-HP, Hôpital Beaujon, DMU PARABOLDépartement d’anesthésie réanimation, AP-HP, Hôpital Beaujon, DMU PARABOLAbstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i), like empagliflozin, are widely prescribed for managing type 2 diabetes mellitus. However, they carry a rare but serious risk: euglycemic diabetic ketoacidosis (EDKA). EDKA’s atypical presentation, characterized by metabolic acidosis and ketosis despite normal blood glucose levels, often delays diagnosis, posing significant challenges in intensive care. Case presentation We report the case of a 74-year-old female with type 2 diabetes on empagliflozin, gliclazide, and metformin. Admitted after severe trauma from a road traffic accident, she subsequently developed EDKA. This was fostered by septic shock due to methicillin-susceptible Staphylococcus aureus cellulitis. All home medications were discontinued. EDKA was successfully managed with fluid volume expansion, continuous intravenous insulin and dextrose infusions, resolving her metabolic derangements within five days. Conclusion SGLT2i use is associated with a significantly increased risk of EDKA. Early diagnosis is critical due to its potential lethal consequences. Reintroducing SGLT2i in ICU patients, especially trauma patients at high sepsis risk, requires careful, daily reassessment given their unpredictable clinical course.https://doi.org/10.1186/s12245-025-00963-8TraumaEuglycemic diabetic ketoacidosisSodium-glucose co transporter 2 inhibitorsSepsis shock |
| spellingShingle | Ophélie Dirand Julie Dupont Emmanuel Weiss Myriam Lamamri Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report International Journal of Emergency Medicine Trauma Euglycemic diabetic ketoacidosis Sodium-glucose co transporter 2 inhibitors Sepsis shock |
| title | Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report |
| title_full | Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report |
| title_fullStr | Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report |
| title_full_unstemmed | Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report |
| title_short | Euglycemic diabetic ketoacidosis associated with a sodium-glucose co transporter 2 inhibitor use in a trauma patient: a case report |
| title_sort | euglycemic diabetic ketoacidosis associated with a sodium glucose co transporter 2 inhibitor use in a trauma patient a case report |
| topic | Trauma Euglycemic diabetic ketoacidosis Sodium-glucose co transporter 2 inhibitors Sepsis shock |
| url | https://doi.org/10.1186/s12245-025-00963-8 |
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