Incidental diagnosis of euglycaemic diabetic ketoacidosis: A case report

Euglycaemic diabetic ketoacidosis (eu-DKA) is a rare but serious complication of sodium-glucose co-transporter 2 (SGLT2) inhibitors, characterized by metabolic acidosis, elevated ketones and may be overlooked because of the absence of marked hyperglycaemia. We present the case of a 57-year-old male with well-controlled type 2 diabetes (HbA1c 6.5%), hypertension and squamous cell carcinoma of the tongue, admitted to Aga Khan University Hospital, Karachi, Pakistan for elective surgery. The diagnosis of euglycaemic DKA was incidental as the patient was asymptomatic and metabolic abnormalities were detected during preoperative laboratory evaluation. Investigations revealed high anion gap metabolic acidosis with ketonuria and a normal blood glucose level (73 mg/dL). He had been on SGLT2 inhibitors and had abstained from solid food intake for two weeks due to his cancer diagnosis. Management included intravenous fluids, insulin infusion and electrolyte monitoring. His metabolic parameters normalized within 8 hours and he was placed on an adjusted basal-bolus insulin regimen.