Empagliflozin-Associated Euglycemic Diabetic Ketoacidosis Masked by Urinary Tract Infection

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 8; p. e66408
• Main Authors: Chauhan, Sukhjinder, Diaz, Victoria, Ogbu, Ikechukwu R, Sanchez, Justin Roy P, Manov, Andre E, Shah, Pinak
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 07.08.2024
• Subjects: Acidosis; Acids; Adenosine; Antidiabetics; Blood pressure; Carbon dioxide; Creatinine; Diabetes; Diabetic ketoacidosis; Diabetic nephropathy; Ejection fraction; FDA approval; Glucagon; Glucose; Heart failure; Insulin; Leukocytes; Metabolism; Nitrogen; Patients; Potassium; Sepsis; Sodium; Urinalysis; Urine; Urogenital system; sglt-2 inhibitors; insulin infusion; anion gap metabolic acidosis; sglt2 eudka; dka protocol; dka; euglycemic ketoacidosis; eudka
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.66408

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated efficacy in slowing the progression of chronic kidney disease (CKD), managing conditions such as congestive heart failure (CHF), and reducing cardiovascular and overall mortality in patients with type 2 diabetes mellitus (T2DM). However, their use is associated with complications, including euglycemic diabetic ketoacidosis (euDKA), genital fungal infections, and urinary tract infections (UTIs). Although rare, complications like euDKA can lead to serious consequences if not promptly addressed, as illustrated by this case report of a 90-year-old man with ischemic cardiomyopathy and type 2 diabetes who developed both euDKA and a UTI while on SGLT2 inhibitor therapy. Early identification of euDKA from SGLT2 inhibitor usage prompted cessation of the SGLT2 inhibitor and administration of insulin infusion, ultimately resolving the life-threatening condition.