title: Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet.
abstract: We present a case of a 32-year-old diabetic woman with Prader-Willi syndrome who developed severe ketoacidosis caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents, during a strict low-carbohydrate diet. At admission, a serum glucose level of 191 mg/dL was relatively low, though laboratory evaluations showed severe ketoacidosis. This is the first report of ketoacidosis caused by a SGLT2 inhibitor. It is necessary to not only pay attention when using a SGLT2 inhibitor in patients following a low-carbohydrate diet, but also to start a low-carbohydrate diet in patients treated with a SGLT2 inhibitor because of a high risk for developing ketoacidosis.
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hayami
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamiya
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Ena
authors.initials: E
authors.lastname: Naito
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Yukako
authors.initials: Y
authors.lastname: Sugiura
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Kojima
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Sami
authors.initials: S
authors.lastname: Sato
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Kasagi
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Toshihito
authors.initials: T
authors.lastname: Ando
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Saeko
authors.initials: S
authors.lastname: Noda
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakai
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Takada
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Asano
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Motegi
authors.affiliation: Center for Preventive Medicine, Chubu Rosai Hospital Nagoya, Aichi, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Watarai
authors.affiliation: Laboratory of Medicine, Aichi Gakuin University School of Pharmacy Nagoya, Aichi, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kato
authors.affiliation: Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine Nagakute, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Nakamura
keywords: Ketoacidosis; Low-carbohydrate diet; Sodium-glucose cotransporter 2 inhibitor