Sodium-Glucose Cotransporter-2 Inhibitor-Associated Euglycemic Diabetic Ketoacidosis After Orthotopic Heart Transplant in a Prediabetic Patient: A Case Report

Transplant Proc. 2021 Oct;53(8):2636-2639. doi: 10.1016/j.transproceed.2021.08.017. Epub 2021 Sep 13.


Postoperative euglycemic diabetic ketoacidosis (euDKA) associated with sodium-glucose cotransporter-2 (SGLT2) inhibitor use has been well-documented and carries a Food and Drug Administration recommendation to hold SGLT2 inhibitors 3 to 4 days before a planned surgical procedure. Unfortunately, many surgical procedures, such as orthotopic heart transplant (OHT), are unplanned and unpredictable. With the increasing use of SGLT2 inhibitors in diabetic and non-diabetic heart failure patients, new challenges in patient management and perioperative risk have arisen. We report a case in which SGLT2 inhibitor-associated euDKA complicated the postoperative course of a prediabetic patient who had undergone OHT.

Publication types

  • Case Reports

MeSH terms

  • Diabetes Mellitus, Type 2*
  • Diabetic Ketoacidosis* / chemically induced
  • Diabetic Ketoacidosis* / diagnosis
  • Glucose
  • Heart Transplantation* / adverse effects
  • Humans
  • Prediabetic State*
  • Sodium
  • Sodium-Glucose Transporter 2 Inhibitors* / adverse effects


  • Sodium-Glucose Transporter 2 Inhibitors
  • Sodium
  • Glucose