Euglycemic ketoacidosis in a non-diabetic patient with Duchenne muscular dystrophy on dapagliflozin

Euglycemic ketoacidosis (EKA) is an uncommon but potentially life-threatening condition characterized by ketoacidosis with normal or mildly elevated blood glucose levels. We report the case of a 24-year-old male with advanced Duchenne muscular dystrophy and cardiomyopathy treated with dapagliflozin, who developed EKA triggered by reduced food intake due to dysphagia and delayed intestinal motility. The patient presented with metabolic acidosis and elevated ketones but maintained normal glucose levels. Discontinuation of dapagliflozin, along with intravenous bicarbonate and dextrose administration, led to clinical and biochemical resolution without the need for insulin therapy. This case highlights the importance of recognizing SGLT2 inhibitor-associated EKA in non-diabetic patients, especially during fasting or stress conditions, to prevent misdiagnosis and ensure prompt management. Increased clinical vigilance and patient education are essential given the expanding use of these agents in non-diabetic populations.