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Empagliflozin-Induced Nondiabetic Ketoacidosis in Advanced Alcoholic Liver Disease
Sudheer Dhoop1, Mohammed Shehada1, Ahmad Abdelrahman1
1Division of General Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.
Abstract:
A 67-year-old man with advanced alcoholic-associated liver disease developed nondiabetic ketoacidosis shortly after starting empagliflozin for congestive heart failure. He presented with high anion-gap metabolic acidosis, elevated beta-hydroxybutyrate levels, and hypoglycemia. The condition resolved promptly after empagliflozin discontinuation and initiation of intravenous fluids, thiamine, and dextrose therapy. This case highlights the risk of early-onset ketoacidosis in patients with cirrhosis and alcohol use treated with sodium-glucose cotransporter-2 inhibitors, emphasizing careful patient selection and vigilant early monitoring of electrolytes and renal function. As the application of sodium-glucose cotransporter-2 inhibitors expands into managing refractory ascites in cirrhotic patients, further studies are required to confirm their safety.
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