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Indian Journal of Emergency Medicine

Volume  11, Issue 2, April - June 2025, Pages 131-135
 

Review Article

Fasting-Associated Euglycemic Diabetic Ketoacidosis in a Patient on SGLT2 Inhibitor Therapy: A Rare and Challenging Diagnostic Dilemma in the Emergency Department

Vijay Kumar S.S.1, Ananth Prasad Rao H.T.2, Shabbir Shekhli3, Anila Jose4

1 Assistant Profesor, Department of Emergency Medicine, Kanachur Institute of Medical Sciences, Deralakatte,  Mangalore 575018, India.  2 Associate Professor, Department of Emergency Medicine, Kanachur Institute of Medical Sciences, Mangalore 575018,  India.  3 Associate Professor, Department of Emergency Medicine, Rajarajeshwari Medical College and Hospital, Bangalore  560074, India. 4 Assistant Professor, Department of General Medicine, Sree Narayana Insti

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DOI: 10.21088/ijem.2395.311X.11225.10

Abstract

Euglycemic diabetic ketoacidosis (eDKA) is a rare but life-threatening condition that can occur in patients taking sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly under conditions of metabolic stress, such as fasting. We report the case of a 45-year-old male with type 2 diabetes who presented to the emergency department with symptoms of nausea, vomiting, and tachypnea following prolonged fasting during a religious observance. Despite normal blood glucose levels, he was diagnosed with eDKA, likely triggered by the combined effects of fasting and SGLT2 inhibitor therapy. This case underscores the importance of considering eDKA in patients on SGLT2 inhibitors, even with normal glucose levels, particularly during periods of fasting or metabolic stress. The management of eDKA follows the principles of traditional diabetic ketoacidosis treatment, including insulin infusion, fluid resuscitation, and electrolyte correction. Awareness of this rare complication is crucial for emergency physicians to ensure timely diagnosis and intervention.
 


Keywords : Euglycemic Diabetic Ketoacidosis (eDKA), SGLT2 Inhibitors, Fasting, Emergency Department
Corresponding Author : Vijay Kumar S.S.