First reported case in Peru of euglycemic ketoacidosis due to sodium-glucose cotransporter-2 inhibitor

Paz-Ibarra J.; Quiroz-Aldave J.E.; Durand-Vásquez M.C.; Concepción-Urteaga L.A.; Rommy D.Q.; Concepción-Zavaleta M.J. · Revista del Cuerpo Medico Hospital Nacional Almanzor Aguinaga Asenjo (2025) · DOI: 10.35434/rcmhnaaa.2025.181.2677

Resumen

Background: Euglycemic diabetic ketoacidosis (EDKA) accounts for up to 7% of cases of diabetic ketoacidosis (DKA) and is characterized by blood glucose levels below 200 mg/dL. It has been associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Case report: We present the case of a 34-year-old male with obesity and type 2 diabetes who, four days prior to admission, began treatment with empagliflozin/metformin 12.5/1000 mg twice daily due to hyperglycemia exceeding 350 mg/dL. He presented to the emergency department with symptoms consistent with DKA and a blood glucose level of 180 mg/dL. The patient was managed with fluid resuscitation and insulin therapy, resulting in significant clinical improvement. Discussion: The typical blood glucose level in EDKA is 184.5 mg/dL, often with false-negative urine ketone results, which can delay diagnosis. Management includes discontinuation of the SGLT-2i, fluid replacement, correction of electrolytes, and insulin administration. Improved recognition of this condition is crucial for early diagnosis and timely management.

Instituciones: Universidad Nacional Mayor de San Marcos; Universidad Nacional de Trujillo; Universidad Científica del Sur