skip to main content

SGLT2 inhibitor-associated euglycemic ketoacidosis — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEndocrinology/MetabolismSGLT2 inhibitor-associated euglycemic ketoacidosisABIM Board

A 58-year-old man with type 2 diabetes and heart failure started empagliflozin 2 months ago. He has nausea and abdominal pain after 2 days of poor oral intake. Glucose is 168 mg/dL, pH is 7.18, bicarbonate is 10 mEq/L, anion gap is 25, beta-hydroxybutyrate is elevated, and lactate is normal. Which of the following is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Intravenous insulin with dextrose-containing fluids and discontinuation of the SGLT2 inhibitor

SGLT2 inhibitors can cause euglycemic ketoacidosis. Treatment requires stopping the SGLT2 inhibitor, intravenous fluids, insulin infusion, electrolyte management, and dextrose to permit insulin until ketosis resolves.

Reference: ADA Standards of Care in Diabetes 2026