{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:47:15Z","timestamp":1793832435972,"version":"4.6.1"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Euglycemic ketoacidosis (EKA) is an uncommon but potentially life-threatening condition characterized by ketoacidosis with normal or mildly elevated blood glucose levels. We report the case of a 24-year-old male with advanced Duchenne muscular dystrophy and cardiomyopathy treated with dapagliflozin, who developed EKA triggered by reduced food intake due to dysphagia and delayed intestinal motility. The patient presented with metabolic acidosis and elevated ketones but maintained normal glucose levels. Discontinuation of dapagliflozin, along with intravenous bicarbonate and dextrose administration, led to clinical and biochemical resolution without the need for insulin therapy. This case highlights the importance of recognizing SGLT2 inhibitor-associated EKA in non-diabetic patients, especially during fasting or stress conditions, to prevent misdiagnosis and ensure prompt management. Increased clinical vigilance and patient education are essential given the expanding use of these agents in non-diabetic populations.<\/jats:p>","DOI":"10.1007\/s11739-025-04058-3","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T10:01:33Z","timestamp":1756720893000},"page":"1865-1867","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Euglycemic ketoacidosis in a non-diabetic patient with Duchenne muscular dystrophy on dapagliflozin"],"prefix":"10.1007","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2263-1593","authenticated-orcid":false,"given":"Ana Mar\u00eda","family":"Guti\u00e9rrez-Baena","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariona","family":"Tegido Mateu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"\u00c1lvarez Schlegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8000-739X","authenticated-orcid":false,"given":"Sandra","family":"Clotet-Vidal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"issue":"23","key":"4058_CR1","doi-asserted-by":"publisher","first-page":"2300","DOI":"10.1056\/NEJMc1701990","volume":"376","author":"M Fralick","year":"2017","unstructured":"Fralick M, Schneeweiss S, Patorno E (2017) Risk of diabetic ketoacidosis after initiation of an SGLT2 inhibitor. N Engl J Med 376(23):2300\u20132302. https:\/\/doi.org\/10.1056\/NEJMc1701990","journal-title":"N Engl J Med"},{"issue":"1","key":"4058_CR2","doi-asserted-by":"publisher","first-page":"33","DOI":"10.3949\/ccjm.92a.24075","volume":"92","author":"AE Mehta","year":"2025","unstructured":"Mehta AE, Zimmerman R (2025) Classic diabetic ketoacidosis and the euglycemic variant: something old, something new. Cleve Clin J Med 92(1):33\u201339. https:\/\/doi.org\/10.3949\/ccjm.92a.24075","journal-title":"Cleve Clin J Med"},{"issue":"5","key":"4058_CR3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2023-003666","volume":"11","author":"E Chow","year":"2023","unstructured":"Chow E, Clement S, Garg R (2023) Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors. BMJ Open Diabetes Res Care 11(5):e003666. https:\/\/doi.org\/10.1136\/bmjdrc-2023-003666","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"2","key":"4058_CR4","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s11606-024-09073-","volume":"40","author":"R Garg","year":"2025","unstructured":"Garg R, Sood N, Bansal O, Hoskote A (2025) Euglycemic ketoacidosis associated with SGLT-2 inhibitors in non-diabetic patients-a narrative review. J Gen Intern Med 40(2):437\u2013442. https:\/\/doi.org\/10.1007\/s11606-024-09073-","journal-title":"J Gen Intern Med"},{"issue":"8","key":"4058_CR5","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.nmd.2018.06.003","volume":"28","author":"TE Doris","year":"2018","unstructured":"Doris TE, Bowron A, Armstrong A, Messer B (2018) Ketoacidosis in Duchenne muscular dystrophy: a report on 4 cases. Neuromuscul Disord 28(8):665\u2013670. https:\/\/doi.org\/10.1016\/j.nmd.2018.06.003","journal-title":"Neuromuscul Disord"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-025-04058-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-025-04058-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-025-04058-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T15:20:16Z","timestamp":1758986416000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-025-04058-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":5,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["4058"],"URL":"https:\/\/doi.org\/10.1007\/s11739-025-04058-3","relation":{},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"16 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was carried out in accordance with the recommendations established by the hospital ethics committee \u201cComit\u00e8 \u00c8tic per a la Investigaci\u00f3 amb medicaments (CEIm)\u201d as well the ethical standards of the 1964 Declaration of Helsinki and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}},{"value":"Informed consent was obtained from the individual participant included in the case report.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}