{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T23:13:03Z","timestamp":1792969983750,"version":"4.5.0"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sodium-glucose cotransporter-2 (SGLT2) inhibitors are increasingly prescribed for heart failure and chronic kidney disease, irrespective of diabetic status. While their cardiovascular and renal benefits are well established, euglycemic ketoacidosis (EKA) remains a rare but potentially life-threatening complication that can occur even in non-diabetic individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report a 58-year-old man with ischemic cardiomyopathy (LVEF 35%) and stage 2 chronic kidney disease who developed nausea, vomiting, and fatigue two weeks after initiating dapagliflozin. Laboratory evaluation revealed high-anion-gap metabolic acidosis (pH 7.21 [reference: 7.35\u20137.45], HCO\n                      <jats:sub>3<\/jats:sub>\n                      <jats:sup>-<\/jats:sup>\n                      12 mmol\/L [reference: 22\u201328 mmol\/L], anion gap 23 mmol\/L [reference: 8\u201316 mmol\/L])with markedly elevated \u03b2-hydroxybutyrate (5.4 mmol\/L) and normal plasma glucose (108 mg\/dL). Diabetes, infection, lactic acidosis, and hepatic dysfunction were excluded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management &amp;amp; outcome<\/jats:title>\n                    <jats:p>The SGLT2 inhibitor was discontinued, and the patient was treated with intravenous saline, insulin infusion, and dextrose. Metabolic parameters normalized within 48 hours, and he was discharged in stable condition. No recurrence was noted at three-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that SGLT2 inhibitors can precipitate euglycemic ketoacidosis even in non-diabetic patients. Because normal glucose levels may obscure recognition, clinicians should maintain a high index of suspicion and perform ketone testing in patients on SGLT2 therapy who present with unexplained gastrointestinal or constitutional symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1746210","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T05:21:24Z","timestamp":1768540884000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case Report: Euglycemic ketoacidosis in a non-diabetic patient: a rare adverse effect of SGLT2 inhibitor therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Sai","family":"Prasad","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, S Nijalingappa Medical College Navanagar","place":["Bagalkote, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hamdard Institute of Medical Sciences and Research","place":["New Delhi, Delhi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudrakshi","family":"Shetty","sequence":"additional","affiliation":[{"name":"Nanavati Max Super Speciality Hospital","place":["Mumbai, Maharashtra,, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snigdha","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of New Mexico Children\u2019s Hospital","place":["Albuquerque, NM, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhi","family":"Parmar","sequence":"additional","affiliation":[{"name":"D Y Patil Medical College","place":["Navi Mumbai, Maharashtra, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Channabasappa","family":"Shivaprasad","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sapthagiri Institute of Medical Sciences","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhi","family":"Dhaduk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Smt. Shantabaa Medical College and General Hospital Amreli","place":["Ahmedabad, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"110668","DOI":"10.1016\/j.nut.2019.110668","article-title":"Euglycemic ketoacidosis induced by therapeutic fasting in a non-diabetic patient","volume":"72","author":"Larroumet","year":"2020","journal-title":"Nutrition"},{"key":"B2","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s13256-022-03347-1","article-title":"Euglycemic diabetic ketoacidosis induced by sodium-glucose cotransporter 2 inhibitor in the setting of prolonged fasting: a case report","volume":"16","author":"Alkatheeri","year":"2022","journal-title":"J Med Case Rep"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0843","article-title":"Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium-glucose cotransporter 2 inhibition","volume":"38","author":"Peters","year":"2015","journal-title":"Diabetes Care"},{"key":"B4","article-title":"Euglycemic diabetic ketoacidosis","author":"Plewa","year":"2021"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-9032","article-title":"Hyperglycemic crises in adult patients with diabetes","volume":"32","author":"Kitabchi","year":"2009","journal-title":"Diabetes Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12245-019-0240-0","article-title":"Euglycemic diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitor use: a case report and review of the literature","volume":"12","author":"Diaz-Ramos","year":"2019","journal-title":"Int J Emerg Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1746210\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:34:20Z","timestamp":1771918460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1746210\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":6,"alternative-id":["10.3389\/fendo.2025.1746210"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1746210","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]},"article-number":"1746210"}}