Euglycemic Diabetic Ketoacidosis (EDKA): An easy to miss complication in Diabetic patients on Sodium Glucose Cotransporter 2(SGLT2) Inhibitors.

Abstract

Euglycemic DKA is often a missed clinical entity which may increase the morbidity and mortality of inpatients. An apparently normal blood sugar levels often leads to diagnostic delay in EDKA.  Blood gas analysis and serum ketones estimation in the appropriate clinical setting should be done to clinch the diagnosis. Objective: To highlight the etio-pathogenesis of EDKA, risk factors, principles of management and therapeutic end points. Discussion: EDKA is being increasingly recognised in Type 2 Diabetes patients, with the introduction of SGLT2 inhibitors. Precipitating factors for EDKA include thin built-underweight patients on SGLT2 inhibitors, inadvertent continuation of SGLT2 inhibitors during sick days along with poor fluid intake etc. This euglycemic state is due to urinary excretion of glucose in the background of insulin deficiency. Once EDKA is established, SGLT2 inhibitor should be discontinued immediately and patient should be treated with standard DKA fluid management protocol. Fluid resuscitation should be continued till urine glycosuria disappears. Conclusion: Prompt and timely recognition of SGLT2 inhibitors induced EDKA and appropriate fluid resuscitation will avoid unnecessary complications and morbidity associated with the condition.