{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:40:13Z","timestamp":1756312813746,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,12,11]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Euglyceamic diabetic ketoacidosis (EuDKA) is an uncommon but serious diabetes mellitus complication associated with risk factors such as fasting, surgery, pregnancy and, more recently, the use of sodium\u2013glucose cotransporter-2 inhibitors (SGLT2i). This case is of a woman with type 2 diabetes and hypertension in her 50s who underwent an incarcerated umbilical hernia repair and abdominoplasty. Two days after discharge, she was readmitted with nausea, vomiting, loss of appetite, low-grade fever and breathing difficulty. Preoperatively, her diabetes management included an SGLT2i. She was diagnosed with EuDKA with high anion gap metabolic acidosis, a medical emergency similar to diabetic ketoacidosis. The normal blood glucose levels in EuDKA can mask the condition, which poses a conundrum for physicians in the emergency department\/intensive care units as it may delay diagnosis and treatment, worsening the outcomes. To mitigate this risk, SGLT2i should be stopped 3\u20134\u2009days before planned surgery with appropriate adjustments to the insulin regimen.<\/jats:p>","DOI":"10.1136\/bcr-2024-260473","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T09:45:18Z","timestamp":1736243118000},"page":"e260473","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Life-threatening dapagliflozin-associated euglycaemic diabetic ketoacidosis in a postoperative patient"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8034-5603","authenticated-orcid":false,"given":"Sajid Hasanali","family":"Mukaddam","sequence":"first","affiliation":[{"name":"ICU, Ibn Al-Nafees Hospital, Manama, Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan Mohammed","family":"Tooblani","sequence":"additional","affiliation":[{"name":"ICU, Ibn Al-Nafees Hospital, Manama, Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1156-1930","authenticated-orcid":false,"given":"Riya","family":"Gupta","sequence":"additional","affiliation":[{"name":"Kasturba Medical College Mangalore, Mangalore, Karnataka, India"},{"name":"Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"2025082709001148000_18.1.e260473.1","doi-asserted-by":"publisher","DOI":"10.2174\/1573399812666160421121307"},{"key":"2025082709001148000_18.1.e260473.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2019.03.014"},{"key":"2025082709001148000_18.1.e260473.3","doi-asserted-by":"crossref","first-page":"7074868","DOI":"10.1155\/2018\/7074868","article-title":"Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis","volume":"2018","author":"Yu","year":"2018","journal-title":"Int J Endocrinol"},{"key":"2025082709001148000_18.1.e260473.4","doi-asserted-by":"crossref","unstructured":"Wojtas C , Rasarmos AP , Naddaf N . Sodium-Glucose Transport Protein 2 Inhibitors Association with Euglycemic Diabetic Ketoacidosis. 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UKCPA handb. perioper. med. 2023. Available: https:\/\/periop-handbook.ukclinicalpharmacy.org\/drug\/dapagliflozin\/ [Accessed 11 Nov 2024]."},{"key":"2025082709001148000_18.1.e260473.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12902-022-01126-z","article-title":"The effect of preoperative sodium-glucose cotransporter 2 inhibitors on the incidence of perioperative metabolic acidosis: A retrospective cohort study","volume":"22","author":"Iwasaki","year":"2022","journal-title":"BMC Endocr Disord"},{"key":"2025082709001148000_18.1.e260473.15","unstructured":"Research C for DE and . FDA revises labels of SGLT2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections. FDA 2023."},{"key":"2025082709001148000_18.1.e260473.16","doi-asserted-by":"crossref","unstructured":"Sanchez DSM , Larios JFDP , Salas JMG , et al . Euglycemic Diabetic Ketoacidosis in Patients Taking Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors: Review of the Literature. 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