Euglycemic Diabetic Ketoacidosis (DKA) With Sodium-Glucose Transport Protein 2 (SGLT-2) Inhibitors

This case highlights a rare yet severe presentation of euglycemic diabetic ketoacidosis (DKA) in a male in his mid-eighties with type 2 diabetes mellitus managed on SGLT-2 inhibitors. Despite nearly normal blood glucose levels, he developed profound metabolic acidosis and elevated ketones, necessitating emergency intervention. Initial treatment with intravenous fluids and insulin led to temporary stabilization. Still, progressive metabolic derangement and multi-organ dysfunction resulted in a transition to palliative care, ultimately leading to his demise. This case underscores the need for heightened clinical awareness, early diagnosis, and cautious use of SGLT-2 inhibitors, particularly in elderly patients with multiple comorbidities.