Euglycemic Ketoacidosis in a non-diabetic patient: a rare adverse effect of sodium-glucose co-transporter type-2 inhibitors. A review based on a case report




Francisca Fonseca, Nephrology Service, Arrábida Local Health Unit, Setúbal, Portugal
Ana Piedade, Nephrology Service, Arrábida Local Health Unit, Setúbal, Portugal
Beatriz Mendes, Nephrology Service, Arrábida Local Health Unit, Setúbal, Portugal
António Inácio, Nephrology Service, Arrábida Local Health Unit, Setúbal, Portugal
Ricardo Pereira, Internal Medicine Service, Arrábida Local Health Unit, Setúbal, Portugal
Mónica Corte-Real, Internal Medicine Service, Arrábida Local Health Unit, Setúbal, Portugal
Elsa Soares, Nephrology Service, Arrábida Local Health Unit, Setúbal, Portugal
Joana Carreira, Internal Medicine Service, Arrábida Local Health Unit, Setúbal, Portugal
Karina Soto, Nephrology Service, Arrábida Local Health Unit, Setúbal, Portugal


Sodium-glucose co-transporter type-2 (SGLT-2) inhibitors (SGLT2i) are increasingly used in clinical practice, with proven benefits in chronic conditions such as diabetes mellitus, heart failure (HF), and chronic kidney disease. Prescription of SGLT2i is a common practice among healthcare providers. It is imperative that clinicians can identify and prevent adverse effects of these drugs. Euglycemic ketoacidosis (eKA) is a rare and potentially serious adverse effect of SGLT2i in patients with diabetes; recent reports indicate that this can also occur in non-diabetic patients. We present the case of an elderly non-diabetic female patient who was treated with SGLT2i for HF and developed eKA.



Keywords: Sodium-glucose co-transporter type-2 inhibitors. Euglycemic ketoacidosis. Heart failure. Diabetes mellitus.