Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce cardiovascular, kidney, and overall mortality. SGLT2i are also associated with a rare adverse event, euglycemic diabetic ketoacidosis (EDKA). This report describes a case of EDKA one day after bariatric surgery in a 51-year-old female with type 2 diabetes mellitus managed with the SGLT2i, canagliflozin. She was following a ketogenic diet for three weeks prior to surgery. The patient made a steady recovery with rapid anion gap closure followed by prolonged non-anion gap metabolic acidosis. Her medical record was tagged with a life-threatening reaction to SGLT2i. The risk of EDKA from SGLT2i may be increased by a low carbohydrate diet or postoperative status. Our case was complicated by hypokalemia, exemplifying the need for aggressive electrolyte management. Further guidance is needed to manage risk factors provoking EDKA and the use of SGLT2i therapy after an episode of EDKA.
Highlights
Diabetic ketoacidosis is an acute complication of diabetes characterized by the triad: uncontrolled hyperglycemia (>250 mg/dl), metabolic acidosis, and ketosis
Euglycemic diabetic ketoacidosis (EDKA) is a subtype that presents with lower serum glucose in the setting of metabolic acidosis and ketosis
EKDA is characterized by severe metabolic acidosis, ketosis, and serum glucose within normal limits
Summary
Diabetic ketoacidosis is an acute complication of diabetes characterized by the triad: uncontrolled hyperglycemia (>250 mg/dl), metabolic acidosis (arterial pH
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