Abstract
BackgroundSodium–glucose cotransporter 2 inhibitors are among the new-generation oral antihyperglycemic agents that have been used in the treatment of type 2 diabetes mellitus. With the recent coronavirus disease 2019 pandemic and rise of cases in the third wave, diagnosis of life-threatening euglycemic diabetic ketoacidosis may easily be overlooked or missed.Case presentationWe present the case of a 37-year-old Malay gentleman with underlying type 2 diabetes mellitus on empagliflozin, who presented to our hospital with symptomatic coronavirus disease 2019 infection and diabetic ketoacidosis. He developed severe rebound euglycemic diabetic ketoacidosis due to the continuous usage of empagliflozin for glycemic control alongside intravenous insulin.ConclusionsPhysicians should have a high index of suspicion in diagnosing and managing euglycemic diabetic ketoacidosis, including withholding treatment of sodium–glucose cotransporter 2 inhibitors during the acute management of diabetic ketoacidosis.
Highlights
Sodium–glucose cotransporter 2 inhibitors are among the new-generation oral antihyperglycemic agents that have been used in the treatment of type 2 diabetes mellitus
Physicians should have a high index of suspicion in diagnosing and managing euglycemic diabetic ketoacidosis, including withholding treatment of sodium–glucose cotransporter 2 inhibitors during the acute management of diabetic ketoacidosis
Empagliflozin is a sodium–glucose cotransporter (SGLT-2) inhibitor that was approved in August 2014 by the Food and Drug Administration (FDA) to be used as an oral antihyperglycemic agent for the treatment of type 2 diabetes mellitus (T2DM) [4], and has since gained popularity due to its cardioprotective properties [5]
Summary
Diagnosis of euDKA secondary to empagliflozin in a patient with COVID-19 can be missed. Health care workers should have a high index of suspicion while managing a patient with COVID-19 presenting with atypical DKA taking SGLT-2 inhibitors, which has become a popular medication among T2DM. Detection, withholding the inciting agent, and instituting appropriate and timely treatment are necessary to avoid further untoward consequences during the COVID-19 pandemic
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