Diabetic ketoacidosis induced by SGLT2 inhibitors in acute ischemic stroke: a report of two cases

Background: Diabetic ketoacidosis (DKA) is a common hyperglycemic emergency characterized by hyperglycemia, metabolic acidosis, and ketonemia. DKA is a rare but serious complication of sodium-glucose cotransporter-2 (SGLT2) inhibitors that requires careful monitoring.Case Report: We present two cases of acute ischemic stroke in patients who developed DKA during the administration of SGLT2 inhibitors. Case 1 was a 70-year-old woman with a right middle cerebral artery (MCA) infarction who developed severe metabolic acidosis and ketonemia on hospital day 5, which resolved after insulin and fluid therapy. Case 2 was a 52-year-old woman with a right MCA infarction and carotid stenosis who developed DKA on hospital day 3. Despite initial resolution, DKA recurred after SGLT2 inhibitor re-administration and permanent discontinuation was necessary.Conclusion: These cases highlight the risk of DKA in the acute phase of ischemic stroke in patients treated with SGLT2 inhibitors.