{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:41:09Z","timestamp":1760028069519,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,5,8]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>We report a case of euglycaemic diabetic ketoacidosis (EDKA) in a 43-year-old woman with type 2 diabetes mellitus who presented to the emergency department with problems of vomiting, cough, shortness of breath and generalised weakness after following a ketogenic diet for 2 weeks. Therapy with sodium glucose transport protein-2 empagliflozin had been started 2 months prior. Initial evaluation revealed high anion gap metabolic acidosis with blood glucose level of 169\u2009mg\/dL. Treatment for EDKA with fluid resuscitation, intravenous insulin and dextrose resolved her acidosis and symptoms in less than 24\u2009hours. Empaglifozin was discontinued on discharge. This entity represents a diagnostic challenge since the differential diagnosis is broad with a potentially misleading clinical presentation that can result in delayed diagnosis and adverse outcomes including acute kidney injury, multiple electrolyte abnormalities, cerebral oedema, acute respiratory distress syndrome, shock and death.<\/jats:p>","DOI":"10.1136\/bcr-2020-235117","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T06:55:45Z","timestamp":1591599345000},"page":"e235117","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Euglycaemic diabetic ketoacidosis in a 43-year-old woman with type 2 diabetes mellitus on SGLT-2 inhibitor (empagliflozin)"],"prefix":"10.1136","volume":"13","author":[{"given":"Azka","family":"Latif","sequence":"first","affiliation":[{"name":"Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA"},{"name":"CHI Creighton Health, Creighton University Medical Center\u2014University Campus, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aheli Arce","family":"Gastelum","sequence":"additional","affiliation":[{"name":"Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akshat","family":"Sood","sequence":"additional","affiliation":[{"name":"Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph Thilumala","family":"Reddy","sequence":"additional","affiliation":[{"name":"Internal Medicine, CHI Health Creighton University Medical Center Bergan Mercy, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,6,7]]},"reference":[{"key":"2025082709443180000_13.6.e235117.1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s11606-008-0829-0","article-title":"Starvation-Induced true diabetic euglycemic ketoacidosis in severe depression","volume":"24","author":"Joseph","year":"2009","journal-title":"J Gen Intern Med"},{"key":"2025082709443180000_13.6.e235117.2","first-page":"e88","article-title":"Euglycemic diabetic ketoacidosis with acute pancreatitis in a patient not known to have diabetes","volume":"1","author":"Prater","year":"2015","journal-title":"AACE Clin Case Rep"},{"key":"2025082709443180000_13.6.e235117.3","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211921"},{"key":"2025082709443180000_13.6.e235117.4","doi-asserted-by":"publisher","DOI":"10.2174\/1573399812666160421121307"},{"key":"2025082709443180000_13.6.e235117.5","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.2886","article-title":"Ketosis and diabetic ketoacidosis in response to SGLT2 inhibitors: basic mechanisms and therapeutic perspectives","volume":"33","author":"Qiu","year":"2017","journal-title":"Diabetes Metab Res Rev"},{"key":"2025082709443180000_13.6.e235117.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504720"},{"key":"2025082709443180000_13.6.e235117.7","unstructured":"Plewa MC , Bryant M , King-Thiele R . 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