Euglycemic diabetic ketoacidosis due to empagliflozin: A case report

Cabanillas-López J.G.; Rodriguez-Chávez L.Á.; Romero-Diaz M.Y.; Vargas-Machuca Carranza C.A. · Medicina Clinica Practica (2026) · DOI: 10.1016/j.mcpsp.2026.100535

Resumen

Empagliflozin, an SGLT-2 inhibitor, has been associated with euglycemic diabetic ketoacidosis (euDKA), a rare but potentially life-threatening complication. We describe a 62-year-old woman with type 2 diabetes who developed euDKA three days after initiating empagliflozin, despite regular insulin use. The patient presented with malaise and confusion, with laboratory findings showing metabolic acidosis (pH 7.19, HCO3 5.8 mmol/L) and normal blood glucose (136 mg/dL). Intensive insulin and glucose infusion therapy were initiated, leading to full metabolic and clinical recovery within 42 h. This case highlights the need for clinical suspicion of euDKA in patients using SGLT-2 inhibitors who present with nonspecific symptoms, even when glycemia remains within normal ranges. Early diagnosis and prompt insulin-based therapy are essential to improve outcomes.

Instituciones: Universidad Privada Antenor Orrego