Related Experiment Video
Updated: Jun 7, 2025

Characterization of Metabolic Status in Nonhuman Primates with the Intravenous Glucose Tolerance Test
Published on: November 13, 2016
Intraoperative Diagnosis of Sodium-Glucose Transporter-2 Inhibitor-Associated Euglycemic Diabetic Ketoacidosis
Bibek Devkota1, Timothy Maxwell1, Jessica Schaedel1
1Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, USA.
Abstract:
Sodium-glucose transporter 2 inhibitors (SGLT2i) are increasingly used in diabetic patients having cardiovascular and renal comorbidities. Despite their benefits for glucose control and reducing cardiovascular complications, they are not without risks. We present a case of euglycemic diabetic ketoacidosis (DKA) in a 60-year-old male with metastatic melanoma and type 2 diabetes mellitus (DM) on empagliflozin, undergoing craniotomy for brain tumor resection. Intraoperatively, high anion gap metabolic acidosis with normal blood sugar levels was observed, leading to the diagnosis of euglycemic DKA. Management included immediate initiation of intravenous insulin with dextrose, which was continued in the neuro-intensive care unit (NICU) postoperatively for three days. Euglycemic DKA is sometimes tricky to diagnose due to the absence of significant hyperglycemia as the name suggests, potentially delaying recognition by clinicians. Early detection, intravenous insulin with dextrose, correction of metabolic derangements, and discontinuation of SGLT2i are essential components of management. This case underscores the necessity of considering euglycemic DKA in SGLT2i-treated patients undergoing surgery, particularly when metabolic acidosis with a high anion gap is present despite normal blood glucose levels.
Related Concept Videos
Glucose Transporters
Facilitated diffusion-glucose transporters (GLUTs) are encoded by the solute-linked carrier (SLC) family 2, subfamily A gene family, or SLC2A. The 14 GLUT protein members are distributed into three classes:
Diabetes Mellitus: Type 2 and Gestational
Hypoglycemia and Glucagon
Diabetes: Symptoms, Diagnosis, and Complications
Oral Hypoglycemic Agents: Glinides
Glucose Absorption Into the Small Intestine

