Euglycemic Diabetic Ketacidosis in a Postoperative Patient with Type 2 Diabetes on Empagliflozin and Linagliptin

Abstract

Introduction: EDKA is defined as a triad comprising high anion gap metabolic acidosis with positive serum and urine ketones when serum glycemic levels are <14mmol/L. EDKA is thought to be facilitated by factors such as partial treatment of DKA, food restriction, alcohol intake, and inhibition of gluconeogenesis Case Description: A 46- year-old lady with type 2 diabetes (T2DM) on Metformin, linagliptin and empagliflozin was admitted for an elective total abdominal hysterectomy with bilateral salpingo- oophorectomy for fibroids. On day 4 post-op, she complained of general malaise and thirst. She was apyrexial and her physical examination was unremarkable. Initial laboratory findings were significant for leucocytosis (13,500/μL), elevated C reactive protein (174), and metabolic acidosis with a bicarbonate of 6mmol/l, H ions 73 nmol/l and blood glucose of 13.9mmol/L. Urinalysis showed glycosuria and proteinuria. Based on these findings, she was diagnosed as euglycemic diabetic ketoacidosis (euDKA) with precipitating factor being surgery and reduced oral intake post procedure and started on insulin drip and intravenous fluids, with monitoring in high dependency unit.