Year: 2025
Type: article
Abstract: Disclosure: K. Shams: None. J. Hawkins: None. SGLT2-Associated Euglycemic Ketoacidosis in a Non-DiabeticIntroduction: Sodium–glucose cotransporter 2 (SGLT2) inhibitors are increasingly prescribed for their multifaceted benefit in serious chronic conditions. Outcomes on mortality and cardiovascular benefit have made these medications an attractive choice for many patients impacted by T2DM and heart failure. Given their additional benefit in slowing the progression of CKD and off-label use for obesity, this class of medication has become a one-stop shop for Americans diagnosed with these co-morbidities. They are generally well-tolerated with non-severe side effects. However, diabetic ketoacidosis is one side effect, although rare, that can have devastating outcomes if not recognized quickly. Rates of ketoacidosis in type 2 diabetics range from 0.16 to 0.76 events per 1000 patient-years. In non-diabetic patients, euglycemic ketoacidosis associated with SGLT-2 inhibitor use is rarely documented. The following case brings attention to this occurrence in order to guide clinicians. Case Presentation: A 55-year-old female with heart failure and no history of diabetes presented to the ED with 3 days of nausea and generalized abdominal pain. She reported several episodes of emesis that were nonbilious and nonbloody in nature. No ETOH use. The patient had been on jardiance 10 mg for 2 years without any complications. Upon arrival, the patient had a respiratory rate of 28 and mildly hypertensive, but the rest of her vitals were unremarkable. Labs were notable for glucose 78, HCO3 11, anion gap 22, beta-hydroxybutyrate level 6.5, and significant ketonuria with glucosuria. Lipase and lactic acid were normal. VBG showed pH 7.18. A1c 5.3% and 5.4%. CT chest/abdomen/pelvis showed no acute findings consistent with her symptoms. She was transferred to ICU and treated with IV insulin and fluids with dextrose. Jardiance was held throughout admission. Her anion gap closed 22 hours after admission. The rest of her hospital course was uncomplicated and she was discharged shortly after with resolution of her symptoms. Follow up labs showed no recurrence of DKA, negative diabetic autoantibody panel, and normal insulin levels. Discussion: Euglycemic DKA is a rare, but well established side effect of SGLT-2 inhibitors. To date, there have been only a few reported cases of euglycemic ketoacidosis in non-diabetic patients on SGLT-2 inhibitors. This case intends to inform clinicians about the pathogenesis of this event such that providers can appropriately diagnose and treat in a timely manner. As the use of SGLT-2 inhibitors rises, non-diabetic patients on SGLT-2 inhibitors for other comorbidities need to be educated on the proper steps to take if they are ill. This case also brings to light questions providers may have regarding management after the acute hospitalization period, such as subsequent monitoring and candidacy for future use of SGLT-2 inhibitors. Presentation: Sunday, July 13, 2025
Source: Journal of the Endocrine Society
Authors: Kiana Shams, Devendra Wadwekar, Jennifer Hawkins
Institution: Dignity Health
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,255
OpenAlex ID: W7093323204