A Case of Euglycemic Diabetic Ketoacidosis Following Canagliflozin Therapy

Abstract Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). In general, DKA characterized by blood sugar over 250 mg/dL, anion-gap metabolic acidosis, and increased plasma or urine ketones. Approximately 2–3% patients can present with normal glucose levels (less than mg/dl) which called euglycemic DKA. Some the etiologies include recent use insulin, low caloric intake, alcoholism, chronic liver disease, pregnancy. Very rarely, SGLT2 inhibitor may be responsible for Case Presentation: Here we case 44 years old female past medical history DM type 2 who presented acute onset nausea vomiting. Initial laboratory findings were remarkable anion gap acidosis level 201 mg/dl. The patient was on long-acting insulin along Canagliflozin Metformin therapy reported being compliant medications. She treated intravenous resolved as well symptoms. discharged recommendations discontinuation Canagliflozin. Discussion: inhibitors are novel class oral antidiabetic drugs widely used due to their favorable cardiovascular renal outcomes independent glycemic control. However, side effects remain concern. rare but serious effect an incidence rate 9.4% in 1 less 0.2% DM. Patients typically euglycemia low-grade hyperglycemia results diagnostic challenge treating physicians. increase urinary excretion subsequent decrease circulating glucagon, rendering shift from fatty acid utilization. During times intercurrent illness (decreased sepsis) stress (surgery), decreased carbohydrate intake coupled aforementioned changes will result secretion counter-regulatory hormones including adrenaline cortisol, promoting lipolysis, oxidation, ketone production ultimately leading Conclusion: induced treatment identical classic consideration lack hyperglycemia. Appropriate counseling ensure safe crucial, appropriate holding parameters during concomitant volume-depleting illnesses intake. Timely diagnosis DKA, recognitions other lethal overall morbidity mortality.