A 45-year-old woman with type 2 diabetes on empagliflozin presents to the emergency department with nausea, vomiting, and abdominal pain. Blood glucose is 180 mg/dL, pH is 7.25, and serum ketones are elevated. Which term best describes this presentation?

• A Hyperosmolar hyperglycemic state
• B Lactic acidosis
• C Euglycemic diabetic ketoacidosis ✓
• D Hyperglycemic hyperketotic crisis

Explanation

Euglycemic DKA is a recognized adverse effect of SGLT2 inhibitors where blood glucose may be only mildly elevated (below 200 mg/dL) despite significant ketosis and metabolic acidosis. The mechanism involves reduced renal glucose reabsorption, increased glucagon-to-insulin ratio, and enhanced lipolysis. It can be triggered by surgery, dehydration, or reduced carbohydrate intake, and patients may not appear as hyperglycemic as in classic DKA.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.