EUGLYCEMIC DIABETIC KETOACIDOSIS AMONG FILIPINO PATIENTS WITH TYPE 2 DIABETES MELLITUS ASSOCIATED WITH SGLT2-INHIBITORS

CASE SERIES

Abstract

OBJECTIVES
Euglycemic diabetic ketoacidosis (EuDKA) is an uncommon but serious adverse effect of SGLT2-i. The use of SGLT2-i is likely to increase because of its beneficial effects on cardiovascular and kidney outcomes which may lead to an increase in the incidence of EuDKA. The study contributes to the body of knowledge on the present data regarding EuDKA.

CASE
This case series included adult patients diagnosed with EuDKA secondary to SGLT2-i in a tertiary training hospital from November 2021 to April 2022. Four patients were iincluded in the study. The most common presenting symptoms include abdo- minal pain, nausea, vomiting and diarrhea. All patients had confirmed type 2 diabetes mellitus. All patients were prescribed with more than 2 oral hypoglycemic medications. Two (50%) patients had heart disease and hypertension. The median age was 67 years, and 2 (50%) were males. The median hemoglobin A1c (HbA1c) on presentation was 8.7% (range: 5.3% - 10.9%. The median BMI was 25 kg/m2. All patients were admitted in the ICU. The median length of ICU stay and hospital was 5 days and 18 days, respectively. The median time to resolution of metabolic acidosis was 30 hours.

CONCLUSION
The diagnosis of EuDKA is elusive due to presenting generalized symptoms and the lack of awareness among patients. Normoglycemia in the setting of metabolic acidosis poses a challenge for diagnosis. Among patients with surgical procedures and history of intake of SGLT2-i, it is important to obtain serum or urine ketones during the post-operative period.