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Euglycaemic diabetic ketoacidosis associated with SGLT2 inhibitor — SCE Acute Medicine MCQ

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HardDiabetes and endocrine medicineEuglycaemic diabetic ketoacidosis associated with SGLT2 inhibitorSCE Acute Medicine

A 58-year-old woman taking an SGLT2 inhibitor presents with abdominal pain and vomiting after a low-carbohydrate diet and missed meals. Glucose is 10.8 mmol/L, ketones are 5.2 mmol/L, pH is 7.21 and bicarbonate is 11 mmol/L. Lactate is normal and she appears dehydrated. What is the most likely diagnosis?

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Correct answer: E — Euglycaemic diabetic ketoacidosis

SGLT2 inhibitors can precipitate euglycaemic DKA, where marked ketonaemia and metabolic acidosis occur with only modest glucose elevation. Starvation ketosis is usually milder and should not produce this degree of acidosis. Recognition is important because treatment still requires DKA protocols with insulin and dextrose as needed.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-90-1