MON-546 Euglycemic Diabetic Ketoacidosis With Recent Initiation Of A SGLT2 Inhibitor Medication In A Patient With T2D

Abstract Disclosure: N. Bhuiya: None. F. Ziyadeh: None. P. Rao: None. Euglycemic diabetic ketoacidosis (EDKA) is a clinical syndrome comprised of euglycemia, ketonemia, and severe metabolic acidosis among individuals with type 1 or type 2 diabetes. With the rise of usage of sodium-glucose transporter 2 (SGLT2) inhibitors, the incidence of EDKA has increased. Without hyperglycemia at presentation, a hallmark sign of DKA, the diagnosis of EDKA can be delayed. We report a case of a 43-year-old female with a history of uncontrolled type 2 diabetes (T2D), hypertension, high-grade squamous intraepithelial lesion of the cervix status-post LEEP, and glaucoma who presented with palpitations, pleuritic chest pain, nausea, lower abdominal pain, back pain, chills and weakness for approximately 2-3 days. Of note, the patient had started empagliflozin 10mg 3 days prior to presenting to the hospital. The patient was previously on dulaglutide and metformin, however, she was only prescribed empagliflozin for current diabetes management. Laboratory tests revealed glucose 166 mg/dL, pH 7.20 on VBG, bicarbonate 9 mmol/L, anion gap 37 mmol/L, and beta-hydroxybutyrate 6.86 mmol/L, which were concerning for euglycemic DKA. Additional laboratory tests exhibited normal C-peptide levels and negative insulin antibody and glutamic acid decarboxylase (GAD). Treatment with IV insulin and IV fluids led to clinical improvement. The patient was discharged with Lantus 20 units and sliding scale insulin (SSI); empagliflozin was discontinued. This case highlights the importance of including EDKA in the differential diagnosis among patients who use SGLT2 inhibitors and present with signs and symptoms of DKA in the setting of euglycemia. Additionally, this case emphasizes that EDKA can develop within a few days of initiating a SGLT2 inhibitor even among individuals without type 1 diabetes or insulin deficiency. A delay in diagnosis and treatment of EDKA can lead to worse outcomes including death. Presentation: Monday, July 14, 2025