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Sodium-glucose cotransporter 2 inhibitor-induced euglycemic diabetic ketoacidosis in a patient with coronavirus disease 2019: a case report

Yii ESS 1 , Azli AW 2 , Sitaram PN 3

Affiliations 

  • 1 Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. [email protected]
  • 2 Department of Anaesthesiology and Intensive Care, Hospital Sungai Buloh, Selangor Darul Ehsan, Malaysia
  • 3 Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
J Med Case Rep, 2022 Jan 04;16(1):17.
PMID: 34983625 DOI: 10.1186/s13256-021-03232-3

Abstract

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors are among the new-generation oral antihyperglycemic agents that have been used in the treatment of type 2 diabetes mellitus. With the recent coronavirus disease 2019 pandemic and rise of cases in the third wave, diagnosis of life-threatening euglycemic diabetic ketoacidosis may easily be overlooked or missed.

CASE PRESENTATION: We present the case of a 37-year-old Malay gentleman with underlying type 2 diabetes mellitus on empagliflozin, who presented to our hospital with symptomatic coronavirus disease 2019 infection and diabetic ketoacidosis. He developed severe rebound euglycemic diabetic ketoacidosis due to the continuous usage of empagliflozin for glycemic control alongside intravenous insulin.

CONCLUSIONS: Physicians should have a high index of suspicion in diagnosing and managing euglycemic diabetic ketoacidosis, including withholding treatment of sodium-glucose cotransporter 2 inhibitors during the acute management of diabetic ketoacidosis.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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