[Euglycemic ketoacidosis - rare condition on the rise]

Area of Science:

• Pharmacology
• Endocrinology
• Cardiology

Background:

• SGLT2 inhibitors are antidiabetic drugs with proven cardiovascular and renal benefits, even in non-diabetic patients.
• These drugs induce ketogenesis, similar to fasting states.
• This mechanism can lead to life-threatening euglycemic ketoacidosis (eKA) under certain conditions.

Purpose of the Study:

• To highlight the risk of euglycemic ketoacidosis (eKA) associated with SGLT2 inhibitors.
• To discuss the diagnostic challenges and management strategies for SGLT2 inhibitor-induced eKA.
• To emphasize the importance of prompt diagnosis and therapy in emergency settings.

Main Methods:

• Review of randomized prospective studies on SGLT2 inhibitors.
• Analysis of case reports and clinical data on euglycemic ketoacidosis.
• Discussion of pathophysiological mechanisms and diagnostic criteria.

Main Results:

• SGLT2 inhibitors can cause euglycemic ketoacidosis (eKA) at a rate of approximately 2:1000 patient-years.
• Diagnosis is challenging due to normal blood glucose levels and potentially misleading ketone and glucose tests.
• Management requires careful attention to blood glucose targets, hydration, and potassium levels.

Conclusions:

• SGLT2 inhibitors, while beneficial, carry a risk of inducing euglycemic ketoacidosis (eKA).
• Physicians must be aware of the diagnostic difficulties and specific management needs for eKA.
• Prompt recognition and treatment are vital, especially with increasing SGLT2 inhibitor prescriptions.