Prolonged euglycemic diabetic ketoacidosis triggered by a single dose of sodium-glucose cotransporter 2 inhibitor

BMJ Case Rep. 2020 Oct 7;13(10):e235969. doi: 10.1136/bcr-2020-235969.


A 45-year-old woman was admitted for diabetic ketoacidosis (DKA). Aggressive rehydration and continuous intravenous insulin resulted in improved blood glucose levels; however, metabolic acidosis persisted. One day prior to admission, the patient took a single dose of a sodium-glucose cotransporter 2 (SGLT2) inhibitor and this likely contributed to the prolonged euglycemic DKA. A single dose of this drug remained effective for over 100 hours as evidenced by massive excretion of urine glucose continuing long after blood glucose normalisation. SGLT2 inhibitor use should be refrained in cases in which DKA has already occurred as they may result in increasing severity or prolonged DKA.

Keywords: diabetes; drugs: endocrine system; primary care.

Publication types

  • Case Reports

MeSH terms

  • Acidosis* / blood
  • Acidosis* / etiology
  • Acidosis* / therapy
  • Administration, Intravenous
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Ketoacidosis* / blood
  • Diabetic Ketoacidosis* / chemically induced
  • Diabetic Ketoacidosis* / physiopathology
  • Diabetic Ketoacidosis* / therapy
  • Drug Monitoring
  • Duration of Therapy
  • Female
  • Fluid Therapy / methods
  • Glycemic Control / methods
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Insulin / administration & dosage*
  • Middle Aged
  • Sodium-Glucose Transporter 2 Inhibitors / administration & dosage
  • Sodium-Glucose Transporter 2 Inhibitors / adverse effects*
  • Treatment Outcome


  • Hypoglycemic Agents
  • Insulin
  • Sodium-Glucose Transporter 2 Inhibitors