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Euglycaemic DKA with SGLT2i — GPhC CRA MCQ

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HardEndocrine TherapeuticsEuglycaemic DKA with SGLT2iGPhC CRA

A 52-year-old woman with type 2 diabetes is prescribed empagliflozin 10 mg daily. She presents 5 days later feeling unwell with nausea, vomiting, abdominal pain, and excessive thirst. Her capillary blood glucose is 9.2 mmol/L. What is the most important differential diagnosis to consider?

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Correct answer: C — Euglycaemic diabetic ketoacidosis

SGLT2 inhibitors are associated with an increased risk of diabetic ketoacidosis (DKA) that can present with normal or only mildly elevated blood glucose (euglycaemic DKA). The MHRA has issued safety warnings about this. Classic symptoms include nausea, vomiting, abdominal pain, excessive thirst, and rapid breathing. A near-normal glucose of 9.2 mmol/L does not exclude DKA. Urgent ketone testing and emergency referral are required. This is a serious and potentially fatal complication.

Reference: MHRA Drug Safety Update; BNF Empagliflozin