Summary

Sodium glucose co-transporter-2 inhibitors (SGLT2-i) have become a popular therapeutic strategy in the management of hyperglycaemia in type 2 diabetes mellitus. The primary site of action of SGLT2-i is at the proximal renal convoluted tubule. They work by blocking SGLT2 receptors, sodium-dependent glucose co-transport molecules, which in turn prevents glucose reabsorption, facilitating glucosuria, improving glycaemic control as well as a moderate degree of weight loss. We report the case of a 51-year-old woman admitted to the acute medical unit with abdominal pain and vomiting, who was diagnosed with euglycaemic diabetic ketoacidosis secondary to recent initiation of an SGLT2-i medication (dapagliflozin). Clinicians should be aware of this rare side effect of SGLT2-i, to circumvent delays in patient management.

Background

Diabetic ketoacidosis is an acute, potentially fatal, complication of diabetes mellitus. Ketoacidosis without the characteristic hyperglycaemia, euglycaemic diabetic ketoacidosis (euDKA), is equally serious but more challenging diagnostically owing to the absence of raised blood sugars. This often leads to delays in diagnosis and management. euDKA has rarely been reported in association with sodium glucose co-transporter-2 inhibitors (SGLT2-i), with the more common side effects of this class of drugs being: urinary tract infections (UTIs), genital infections, hypovolaemia and dehydration.

However, given the morbidity and mortality associated with diabetic ketoacidosis, the diagnosis of euDKA should be considered in all patients taking SGLT2-i medication.

Here we report the case of a 51-year-old woman who was admitted to the acute medical unit with abdominal pain and vomiting, who had been diagnosed with euDKA …