{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:59:31Z","timestamp":1776783571702,"version":"3.51.2"},"reference-count":16,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,6,8]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>Sodium glucose cotransporter-2 (SGLT2) inhibitors are glucose-lowering drugs with proven efficacy in treating type 2 diabetes mellitus, and more recently, have been shown to improve heart failure outcomes in patients without diabetes. A rare complication of SGLT2 inhibitor use is the development of euglycaemic diabetic ketoacidosis (EDKA), characterised by euglycaemia (blood glucose level &lt;250\u2009mg\/dL), metabolic acidosis (arterial pH &lt;7.3\u2009and serum bicarbonate &lt;18\u2009mEq\/L), and ketonaemia. Given patients with EDKA do not present with the typical manifestations of diabetic ketoacidosis, including marked hyperglycaemia and dehydration, the diagnosis of EDKA may be missed and initiation of treatment delayed. We present the case of a man with recent SGLT2 inhibitor use and multiple other risk factors who developed EDKA.<\/jats:p>","DOI":"10.1136\/bcr-2021-247921","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T12:01:21Z","timestamp":1655899281000},"page":"e247921","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Euglycaemic diabetic ketoacidosis in a patient with pancreatitis and type 2 diabetes on empagliflozin"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5985-3372","authenticated-orcid":false,"given":"Olgert","family":"Bardhi","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew D","family":"Bloom","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Sattari","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"2025082622473262000_15.6.e247921.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.045691"},{"key":"2025082622473262000_15.6.e247921.2","doi-asserted-by":"crossref","first-page":"3298","DOI":"10.1002\/ehf2.13169","article-title":"Efficacy and safety of SGLT2 inhibitors in heart failure: systematic review and meta-analysis","volume":"7","author":"Butler","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2025082622473262000_15.6.e247921.3","unstructured":"Plewa MC , Bryant M , King-Thiele R . Euglycemic diabetic ketoacidosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554570\/"},{"key":"2025082622473262000_15.6.e247921.4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ejim.2019.03.014","article-title":"Euglycemic diabetic ketoacidosis","volume":"63","author":"Barski","year":"2019","journal-title":"Eur J Intern Med"},{"key":"2025082622473262000_15.6.e247921.5","first-page":"17","article-title":"Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma","volume":"2017","author":"Rawla","year":"2017","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"2025082622473262000_15.6.e247921.6","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/4095789"},{"key":"2025082622473262000_15.6.e247921.7","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1016\/j.clinthera.2016.11.002","article-title":"Sglt2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis","volume":"38","author":"Goldenberg","year":"2016","journal-title":"Clin Ther"},{"key":"2025082622473262000_15.6.e247921.8","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ajem.2021.02.015","article-title":"Euglycemic diabetic ketoacidosis: etiologies, evaluation, and management","volume":"44","author":"Long","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2025082622473262000_15.6.e247921.9","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/ams2.13","article-title":"Alcoholic ketoacidosis that developed with a hypoglycemic attack after eating a high-fat meal","volume":"1","author":"Suzuki","year":"2014","journal-title":"Acute Med Surg"},{"key":"2025082622473262000_15.6.e247921.10","unstructured":"Lizzo JM , Goyal A , Gupta V . Adult Diabetic Ketoacidosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560723\/"},{"key":"2025082622473262000_15.6.e247921.11","article-title":"Euglycemic diabetic ketoacidosis and sodium-glucose cotransporter-2 inhibitors: a focused review of pathophysiology, risk factors, and triggers","volume":"13","author":"Somagutta","year":"2021","journal-title":"Cureus"},{"key":"2025082622473262000_15.6.e247921.12","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":"2025082622473262000_15.6.e247921.13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2022\/4101975","article-title":"Euglycemic diabetic ketoacidosis after discontinuing SGLT2 inhibitor","volume":"2022","author":"Alhemeiri","year":"2022","journal-title":"Case Rep Endocrinol"},{"key":"2025082622473262000_15.6.e247921.14","article-title":"A case of severe metabolic acidosis due to Jardiance-Induced euglycemic diabetic ketoacidosis","volume":"13","author":"Dyatlova","year":"2021","journal-title":"Cureus"},{"key":"2025082622473262000_15.6.e247921.15","first-page":"266","article-title":"Euglycemic diabetic ketoacidosis (EDKA) in a patient receiving dapagliflozin","volume":"17","author":"Sethi","year":"2021","journal-title":"Acta Endocrinol"},{"key":"2025082622473262000_15.6.e247921.16","doi-asserted-by":"crossref","first-page":"828649","DOI":"10.3389\/fsurg.2022.828649","article-title":"New diabetic medication sodium-glucose cotransporter-2 inhibitors can induce euglycemic ketoacidosis and mimic surgical diseases: a case report and review of literature","volume":"9","author":"Kietaibl","year":"2022","journal-title":"Front Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:47:45Z","timestamp":1756273665000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,22]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/bcr-2021-247921"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247921","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6]]}}}