A 46-year-old man with type 2 diabetes takes empagliflozin, metformin and ramipril. He is admitted with vomiting and abdominal pain 3 days after

Question

A 46-year-old man with type 2 diabetes takes empagliflozin, metformin and ramipril. He is admitted with vomiting and abdominal pain 3 days after starting a ketogenic diet. Glucose is 10.8 mmol/L, bicarbonate 13 mmol/L, pH 7.24 and blood ketones 5.1 mmol/L. What is the most likely diagnosis?

Accepted Answer

Euglycaemic diabetic ketoacidosis

Answer

Lactic acidosis from metformin

Answer

Acute pancreatitis without ketoacidosis

Answer

Hyperosmolar hyperglycaemic state

Answer

Starvation ketosis without acidosis

SGLT2 inhibitor-associated euglycaemic ketoacidosis — SCE Endocrinology MCQ

A 46-year-old man with type 2 diabetes takes empagliflozin, metformin and ramipril. He is admitted with vomiting and abdominal pain 3 days after starting a ketogenic diet. Glucose is 10.8 mmol/L, bicarbonate 13 mmol/L, pH 7.24 and blood ketones 5.1 mmol/L. What is the most likely diagnosis?