Sodium-Glucose Co-transporter 2 Inhibitor-Associated Euglycemic Diabetic Ketoacidosis in a Recipient of Concurrent Pancreas-Kidney Transplantation With Type 1 Diabetes Mellitus

Currently, sodium-glucose co-transporter 2 inhibitors (SGLT2is) are used frequently in a range of patients, including those with type 1 diabetes mellitus, raising concerns regarding the potential increased risk of SGLT2i-associated euglycemic diabetic ketoacidosis (EDKA). We report the case of a patient with type 1 diabetes who developed SGLT2i-associated EDKA during the perioperative period of concurrent pancreas and kidney transplantation procedure. A 41-year-old woman taking an SGLT2i underwent concurrent pancreas and kidney transplantation from a brain-dead donor. Acidosis was noted during surgery, which improved temporarily after the pancreas was transplanted. The pancreatic allograft was resected because of twisting of the anastomotic vessels, and acidosis recurred. The patient's blood glucose levels were consistently within the normal range. Blood ketone monitoring was initiated, and the patient was diagnosed with EDKA. Patients with type 1 diabetes taking SGLT2is who undergo emergency surgery are at risk of EDKA and should continually monitor their ketone levels.