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Euglycaemic diabetic ketoacidosis — SCE Endocrinology MCQ

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HardDiabetic emergenciesEuglycaemic diabetic ketoacidosisSCE Endocrinology

A 36-year-old man with type 1 diabetes is admitted with vomiting and abdominal pain after starting an SGLT2 inhibitor bought privately for weight loss. Glucose is 12.4 mmol/L, ketones 5.1 mmol/L, venous pH 7.18 and bicarbonate 11 mmol/L. What is the most likely diagnosis?

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

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Correct answer: A — Euglycaemic diabetic ketoacidosis

Euglycaemic diabetic ketoacidosis is best because SGLT2 inhibitor exposure can produce ketoacidosis with modest glucose, especially in insulin-deficient patients. The alternatives are less appropriate because HHS needs extreme hyperglycaemia and osmolality; alcoholic ketosis lacks the diabetes/SGLT2 trigger; metformin acidosis is lactate-driven; starvation ketosis is usually less acidotic. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: JBDS-IP DKA guideline; MHRA SGLT2 safety advice