Sodium-Glucose Cotransporter-2 Inhibitors and Euglycemic Diabetic Ketoacidosis: A Case Series of Three Post-surgical Patients

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of commonly prescribed medications used in diabetes management for both their cardiovascular and renal benefits. However, as a class, SGLT2 inhibitors have a known side effect risk for ketoacidosis, including the rarer version called euglycemic diabetic ketoacidosis (DKA). We present three cases of euglycemic DKA postoperatively, in patients who were on SGLT2 inhibitors for type 2 diabetes mellitus. A DKA protocol was initiated for all three patients, and after treatment with fluid and insulin therapy, all patients recovered. All three were restarted on their SGLT2 inhibitor upon discharge. Based on this limited experience, we recommend close monitoring of postoperative patients on SGLT2 inhibitors to allow early detection of euglycemic DKA. Larger trials are needed to determine the exact, optimal timing of restarting SGLT2 inhibitors postoperatively.