A 55-year-old woman takes empagliflozin, metformin and ramipril. She presents with vomiting, abdominal pain and rapid breathing after a viral

Question

A 55-year-old woman takes empagliflozin, metformin and ramipril. She presents with vomiting, abdominal pain and rapid breathing after a viral illness; her capillary glucose is 9.8mmol/L. What is the most appropriate action?

Accepted Answer

Refer urgently for possible euglycaemic diabetic ketoacidosis and advise withholding empagliflozin during acute illness.

Answer

Advise stopping metformin permanently and no further assessment.

Answer

Recommend loperamide and continuing diabetes medicines unchanged.

Answer

Advise taking an extra empagliflozin dose to clear ketones.

Answer

Reassure her because ketoacidosis is associated with very high glucose.

SGLT2 inhibitor euglycaemic ketoacidosis — GPhC CRA MCQ

A 55-year-old woman takes empagliflozin, metformin and ramipril. She presents with vomiting, abdominal pain and rapid breathing after a viral illness; her capillary glucose is 9.8mmol/L. What is the most appropriate action?