title: Euglycaemic diabetic ketoacidosis in a patient with type 2 diabetes started on empagliflozin.
abstract: Diabetes ketoacidosis (DKA) is largely associated with type 1 diabetes and has hyperglycaemia as a cardinal feature. We discuss the case of a 42-year-old man, a patient with type 2 diabetes, who presented to the emergency room, with nausea, vomiting and abdominal pain. He had recently changed his diabetes medications and started on an SGLT2 inhibitor (empagliflozin) along with metformin, pioglitazone, liraglutide and self-adjusted exogenous insulin. DKA was suspected in the wake of clinical examination and lab findings but glucose levels were below the cut-off for DKA; therefore, he was diagnosed with euglycaemic DKA. He was successfully managed with intravenous hydration and insulin infusion. We discuss the link of SGLT2 inhibitors with DKA and the pathophysiology behind euglycaemic DKA.
authors.affiliation: Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: Owais
authors.initials: O
authors.lastname: Rashid
authors.affiliation: Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: Saad
authors.initials: S
authors.lastname: Farooq
authors.affiliation: Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: Zareen
authors.initials: Z
authors.lastname: Kiran
authors.affiliation: Department of Endocrinology, The Aga Khan University Hospital, Karachi, Sindh, Pakistan.
authors.forename: Najmul
authors.initials: N
authors.lastname: Islam
mesh_terms: D000328:Adult; D001559:Benzhydryl Compounds / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000139:chemically induced* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005960:Glucosides / Q000009:adverse effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D000069450:Liraglutide / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D000077205:Pioglitazone; D051297:Sodium-Glucose Transporter 2; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D001559:Benzhydryl Compounds; D005960:Glucosides; D007004:Hypoglycemic Agents; D007328:Insulin; C089180:SLC5A2 protein, human; D051297:Sodium-Glucose Transporter 2; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D045162:Thiazolidinediones; D000069450:Liraglutide; D008687:Metformin; C570240:empagliflozin; D000077205:Pioglitazone