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Euglycaemic DKA from SGLT2 inhibitor — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesEuglycaemic DKA from SGLT2 inhibitorSCE Acute Medicine

A patient taking empagliflozin is being treated for euglycaemic diabetic ketoacidosis. After four hours, glucose is 7.2 mmol/L but ketones are 3.8 mmol/L and bicarbonate is 14 mmol/L. What is the most appropriate adjustment?

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Correct answer: C — Add intravenous glucose and continue fixed-rate insulin

In euglycaemic DKA, insulin must continue until ketonaemia and acidosis resolve even when glucose is normal. Intravenous glucose permits ongoing fixed-rate insulin while preventing hypoglycaemia. Resolution is judged by ketones, bicarbonate and pH rather than glucose alone, and the SGLT2 inhibitor remains withheld.

Reference: https://onlinelibrary.wiley.com/doi/10.1111/dme.14788