SHM Converge Scientific Abstract ePoster Gallery-The Perfect Recipe for Euglycemic Diabetic Ketoacidosis: Sugar-Free and Septic, With a Hint of SGLT-2 Inhibition

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This case report describes a 46-year-old man with type 2 diabetes who developed euglycemic diabetic ketoacidosis (EDKA), a dangerous form of diabetic ketoacidosis that can occur despite normal or only mildly elevated blood glucose. He had recently undergone thyroidectomy, then began a ketogenic, intermittent fasting diet while taking empagliflozin, an SGLT-2 inhibitor. He also presented with community-acquired pneumonia and bacteremia due to Streptococcus pneumoniae.<br /><br />On admission, he had cough, shortness of breath, fatigue, tachycardia, and lab findings consistent with severe metabolic acidosis and ketosis: glucose 139 mg/dL, bicarbonate 6 mmol/L, anion gap 36, and beta-hydroxybutyrate 5 mmol/L. Urinalysis showed ketones and glucose. Chest CT demonstrated multifocal pneumonia. He was treated with IV insulin, dextrose-containing fluids, antibiotics, and electrolyte support. His acidosis improved, and he was later transitioned to basal-bolus insulin and discharged on insulin plus IV ceftriaxone.<br /><br />The report explains that SGLT-2 inhibitors can increase the risk of EDKA by promoting glucosuria and a relative carbohydrate deficit. In this patient, the combination of SGLT-2 inhibition, caloric restriction from a ketogenic/intermittent fasting diet, recent surgery, infection, and dehydration created a “carbohydrate starvation” state that triggered ketone production and EDKA.<br /><br />The authors emphasize the importance of patient education and clinician awareness. Normal glucose levels do not exclude EDKA, and patients on SGLT-2 inhibitors should be warned about fasting, surgery, illness, and dietary restriction. Urine ketone testing should be considered when patients feel unwell.

Asset Subtitle

Kajal Patel

Meta Tag

Author List Kajal Patel, Usha Anand

Category Clinical Vignettes

Concept Euglycemic Diabetic Ketoacidosis

Concept Metabolic Acidosis

Concept Ketonemia

Concept SGLT-2 Inhibitors

Concept Continuous Intravenous Insulin Therapy

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Kajal Patel

Track Adult

Keywords

euglycemic diabetic ketoacidosis

type 2 diabetes

empagliflozin

SGLT-2 inhibitor

ketogenic diet

intermittent fasting

thyroidectomy

pneumonia

Streptococcus pneumoniae bacteremia

ketosis

Euglycemic Diabetic Ketoacidosis

Metabolic Acidosis

Ketonemia

SGLT-2 Inhibitors

Continuous Intravenous Insulin Therapy