North Texas Research Forum 2023



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North Texas


Medical City Arlington


Internal Medicine

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diabetic ketoacidosis, DKA, diabetes mellitus, Euglycemic DKA, carbohydrate restricted diet


Endocrine System Diseases | Internal Medicine


Euglycemic diabetic ketoacidosis (EuDKA) is a rare complication of type 2 diabetes mellitus (T2DM) characterized by normoglycemia in the presence of anion gap metabolic acidosis and blood ketone. EuDKA has been associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) but the reported adverse events are scarce. We present a case of a 68-year-old gentleman with T2DM and coronary artery disease, who developed EuDKA after starting empagliflozin (Jardiance) with a low-carbohydrate diet for a few days. SGLT2i block proximal tubule glucose reabsorption, resulting in a state of carbohydrate starvation and subsequent ketosis. The combination of SGLT2i with a low-carbohydrate diet can enhance ketosis further, causing EuDKA. Because EuDKA is uncommon, delayed diagnosis and treatment can lead to other complications and prolonged hospitalization. SGLT2i has become popular for its antihyperglycemic, cardiovascular, and renal health benefits; however, physicians should be cautious to prescribe this medication when the patient is on a low-carbohydrate diet.

Original Publisher

HCA Healthcare Graduate Medical Education

Euglycemic Diabetic Ketoacidosis Secondary to SGLT2 Inhibitors in Combination with a Low-Carbohydrate Diet

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