Euglisemic diabetic ketoacidotic coma caused by dapagliflozin

Area of Science:

• Endocrinology
• Pharmacology
• Emergency Medicine

Background:

• Diabetic ketoacidosis (DKA) is a severe complication of diabetes mellitus (DM).
• Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are oral antihyperglycemic agents.
• SGLT-2 inhibitors are associated with rare cases of euglycemic DKA (eDKA).

Observation:

• eDKA presents a diagnostic challenge in the emergency department (ED) due to the absence of significant hyperglycemia.
• Altered mental status can be a presenting symptom of eDKA.
• This study details a clinical case of a patient presenting with altered mental status after taking the SGLT-2 inhibitor dapagliflozin.

Findings:

• The patient admitted to the ED exhibited altered mental status.
• The patient had recently been administered dapagliflozin, an SGLT-2 inhibitor.
• The case highlights the potential for eDKA in patients using SGLT-2 inhibitors.

Implications:

• Early recognition of eDKA is crucial for timely intervention and preventing adverse outcomes.
• Clinicians should consider eDKA in patients on SGLT-2 inhibitors presenting with altered mental status, even without hyperglycemia.
• This case underscores the importance of medication history in diagnosing complex metabolic emergencies.