To describe a case of severe euglycemic diabetic ketoacidosis (euDKA) occurring shortly after the initiation of an SGLT2 inhibitor in a treatment-naive patient.
Approach:
Case Presentation: A 40-year-old woman with newly diagnosed type 2 diabetes was treated with metformin, henagliflozin, and chiglitazar. She developed gastrointestinal symptoms leading to reduced oral intake and subsequently presented with euDKA within 4 days.
Key Findings:
The patient developed severe euDKA characterized by high-anion-gap metabolic acidosis (pH 7.043, bicarbonate 6.5 mmol/L) and ketonemia (β-hydroxybutyrate 5.6 mmol/L) within 4 days of starting SGLT2 inhibitor therapy.
Common gastrointestinal side effects of metformin contributed to reduced oral intake and dehydration, precipitating euDKA.
Interpretation:
Limitations:
The case is a single report and may not represent broader patient populations.
No serum drug levels were measured for the medications involved.
