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

• Autores: Paz-Ibarra, José, Quiroz-Aldave, Juan Eduardo, Durand-Vásquez, María del Carmen, Concepción-Urteaga, Luis Alberto, Díaz Quispe, Rommy, Concepción-Zavaleta, Marcio José
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo
• Repositorio: Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo
• Lenguaje: español
• OAI Identifier: oai:cmhnaaa_ojs_cmhnaaa.cmhnaaa.org.pe:article/2677
• Enlace del recurso: https://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/2677
• Nivel de acceso: acceso abierto
• Materia: Inhibidores del Cotransportador de Sodio-Glucosa Tipo 2; Cetoacidosis Diabética; Cetoacidosis; Efectos Adversos y Reacciones Adversas a Medicamentos; Diabetes Mellitus; Informes de Casos; Sodium-Glucose Transporter 2 Inhibitors; Diabetic Ketoacidosis; Ketosis; Drug-Related Side Effects and Adverse Reactions; Case Reports

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.