Euglycemic Diabetic Ketoacidosis Following Ertugliflozin Initiation Precipitated by Norovirus Gastroenteritis
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with an increased risk of euglycemic diabetic ketoacidosis (euDKA), a potentially life-threatening complication that can be difficult to recognize due to near-normal blood glucose levels. While infection is a known precipitant of DKA, viral gastroenteritis as a specific trigger for SGLT2 inhibitor-associated euDKA has not been well-characterized. Case Report: A 36-year-old female with type 2 diabetes mellitus presented with severe metabolic acidosis (pH 6.85), anion gap of 23 mEq/L, and blood glucose of 165 mg/dL 1 week after initiating ertugliflozin 15 mg daily in the setting of recent norovirus exposure. The patient was treated per institutional DKA protocol with intravenous fluids, insulin infusion, and dextrose. Ertugliflozin was discontinued and the patient made a full recovery within 48 h. Discussion: This case illustrates the synergistic mechanism by which norovirus gastroenteritis can precipitate euDKA in patients recently initiated on SGLT2 inhibitors. Viral gastroenteritis causes rapid volume depletion through vomiting and diarrhea, reduced oral carbohydrate intake, and counter-regulatory hormone activation - all of which compound the ketogenic effects of SGLT2 inhibition. Clinicians should counsel patients initiating SGLT2 inhibitors about sick day management and the importance of temporarily discontinuing these agents during acute gastrointestinal illness.
Source: AACE Endocrinology and Diabetes
Authors: T. Michael Farley, Sara Nezirevic
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7161307346