12621 Convergence Of Sglt2 Inhibitors And Glp1 Agonists: Unveiling The Recipe For Euglycemic Diabetic Ketoacidosis

Abstract

Abstract Disclosure: U. Syed: None. N.E. Fretes Oviedo: None. V. Variar: None. Introduction: Euglycemic diabetic ketoacidosis (DKA) is a known adverse effect associated with the use of SGLT2 inhibitors. The concomitant initiation of GLP1 agonists with SGLT2 inhibitors presents a potential synergistic risk, precipitating metabolic acidosis without significant hyperglycemia. The individual propensity of both medication classes to contribute to metabolic disturbances highlights the necessity for heightened clinical awareness. Clinical Case: We present a case of a 34-year-old female with morbid obesity and Type 2 diabetes mellitus, receiving tirzepatide, metformin, and empagliflozin. The patient was initiated on empagliflozin 4 days prior, and tirzepatide one day prior to presentation. Shortly after commencing tirzepatide, she experienced symptoms of decreased appetite, abdominal pain, and vomiting. Workup was consistent with DKA with blood glucose < 250 mg/dL. Management involved strict adherence to DKA protocols. The patient’s symptoms resolved with resolution of ketoacidosis. Conclusion: Euglycemic DKA poses a diagnostic challenge for patients on SGLT2 inhibitors. Concurrent administration of GLP1 agonists, while not directly implicated, may exacerbate this condition, by their gastrointestinal side effects and resultant metabolic abnormalities. Awareness of potential interactions and associated risk factors is crucial for timely diagnosis and management. Presentation: 6/3/2024