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SGLT2 inhibitor euglycaemic ketoacidosis — FRCA Final MCQ

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HardPerioperative MedicineSGLT2 inhibitor euglycaemic ketoacidosisFRCA Final

A 64-year-old man with type 2 diabetes is listed for elective laparoscopic colectomy. He takes empagliflozin and metformin. On admission he feels nauseated; capillary glucose is 9.8 mmol/L, ketones are 3.2 mmol/L and bicarbonate is 16 mmol/L. What is the most appropriate management?

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Correct answer: C — Postpone surgery and treat suspected euglycaemic ketoacidosis

SGLT2 inhibitors can cause euglycaemic ketoacidosis with modest glucose elevation, raised ketones and metabolic acidosis. Elective surgery should be postponed and ketoacidosis treated. Normal-ish glucose does not exclude a serious metabolic emergency. Preoperative assessment should include drug cessation planning and ketone testing when symptoms or risk factors are present.

Reference: CPOC/Association of Anaesthetists peri-operative diabetes guidance 2026