{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T10:57:05Z","timestamp":1777114625549,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ketoacidosis, a life\u2010threatening disease, can be caused by diabetes, alcohol consumption, and severe malnutrition, which are not uncommon in psychiatry. Diabetic and alcoholic ketoacidosis (AKA) are particularly frequent, and differentiating between these two is essential in terms of the substantially different treatment interventions. In recent years, the advent of sodium\u2010glucose co\u2010transporter 2 (SGLT2) inhibitors has made this distinction more difficult, mainly due to the increase in euglycemic diabetic ketoacidosis (euDKA)\u2014ketoacidosis in normal or near\u2010normal blood sugar levels\u2014in the presence of SGLT2 inhibitors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We describe a 52\u2010year\u2010old man's case of severe euDKA caused by an SGLT2 inhibitor with alcohol use disorder. We initially suspected mainly AKA due to his mild disturbance of consciousness, habitual high intake of alcohol, and almost normal blood glucose level (142\u2009mg\/dL). We administered supplemental fluids and vitamin B complex instead of insulin, which is needed for euDKA, but his disorientation and metabolic acidosis worsened. Upon recognizing his inadequate response to fluid replacement and considering his history of SGLT2 inhibitor use, we identified euDKA as the primary pathology. Implementing continuous insulin therapy and tight glycemic control resulted in a rapid improvement in the patient's condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even with normal or near\u2010normal blood sugar levels in a patient with suspected AKA, missing the possibility of euDKA can be fatal. Therefore, psychiatrists should remain vigilant for euDKA, especially in patients using SGLT2 inhibitors, by conducting frequent blood gas examinations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70279","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:15:28Z","timestamp":1766996128000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Stereotypical diagnostic bias for alcohol\u2010induced ketoacidosis could lead to death: Normal blood sugar levels in SGLT2 blocker\u2010induced severe diabetic ketoacidosis"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3570-9186","authenticated-orcid":false,"given":"Shun","family":"Kudo","sequence":"first","affiliation":[{"name":"Department of Psychiatry Saitama City Hospital Saitama Japan"},{"name":"Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sho","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Saitama City Hospital Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yurina","family":"Nanahara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Saitama City Hospital Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takao","family":"Katahira","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Saitama City Hospital Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayoshi","family":"Makio","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Saitama City Hospital Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikiko","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry 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