# Euglycemic Diabetic Ketoacidosis Induced by Sodium-Glucose Cotransporter-2 Inhibitor Use and Coronary Angiography: A Case Report

## TL;DR

A type 2 diabetic patient on SGLT-2 inhibitors developed euglycemic diabetic ketoacidosis after a heart procedure.

## Contribution

Highlights EDKA as a rare but underdiagnosed complication linked to SGLT-2 inhibitors and coronary angiography.

## Key findings

- EDKA occurred in a well-controlled diabetic patient using SGLT-2 inhibitors.
- Coronary angiography may contribute to EDKA in susceptible individuals.
- EDKA presents with normal blood glucose levels, making diagnosis challenging.

## Abstract

Euglycemic diabetic ketoacidosis (EDKA) is an uncommon subtype of diabetic ketoacidosis (DKA) which presents with similar laboratory findings to classic DKA with the exception of blood glucose levels being under 250 mg/dl. EDKA has several etiologies including pregnancy, starvation and the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2). SGLT-2 inhibitors such as empagliflozin and dapagliflozin are increasing in popularity due to their positive benefits for patients with diabetes mellitus and cardiac disease. EDKA is underdiagnosed as it presents with blood sugar levels lower than expected in classic DKA. This case report describes a well-controlled type 2 diabetic patient prescribed an SGLT-2 inhibitor who developed EDKA after undergoing coronary angiography for acute heart failure.