MON-656 SGLT2-Inhibitor-induced Diabetic Ketoacidosis with Hypothermia

Abstract Disclosure: C. Son: None. S. Sakagami: None. A. Uchiyama: None. S. Kiyobayashi: None. Y. Fujiwara: None. Diabetic ketoacidosis (DKA) is one of the most serious life-threatening complications of diabetes mellitus. There are reports that 12% of DKA cases present with hypothermia. Since hypothermia is a potentially fatal condition, the combination of these two complications may lead to a poorer prognosis. Sodium-glucose cotransporter 2 inhibitors (SGLT2Is) are antidiabetic drugs that improve cardiovascular and renal outcomes. However, they can cause DKA without a significant increase in blood glucose levels. The pathophysiology of SGLT2I-induced DKA is thought to differ in several aspects from that of typical DKA, but the details remain unclear. To date, there have been no reports of hypothermia complicating SGLT2I-induced DKA.We describe a case of SGLT2I-induced DKA accompanied by hypothermia. A woman in her 70s was transported to the emergency department due to loss of consciousness. She had been treated for type 2 diabetes mellitus with oral hypoglycemic agents (SGLT2Is, sulfonylureas, biguanides, and DPP-4 inhibitors) but had poor glycemic control, with an HbA1c of 10.1%. Around November X-2, the patient experienced poor oral intake but managed to continue taking her medication. On day X, she was found collapsed at home by a family member. On arrival, she had hypothermia with a body temperature of 31.7 degree C, and her laboratory data revealed the presence of urinary ketones, hyperglycemia (357 mg/dL), and metabolic acidosis with an anion gap of 28.5 mEq/L. Her serum C-peptide level was 1.4 ng/mL, indicating no absolute insulin deficiency. Given the relatively mild increase in blood glucose levels and her clinical course, the patient was diagnosed with SGLT2I-induced DKA. With insulin and glucose infusion, acidemia improved within the first hospital day. External warming was performed to treat hypothermia, and her body temperature rapidly returned to normal. No recurrence of acidemia or hypothermia was observed. After achieving adequate oral intake and adjusting her oral hypoglycemic regimen, the patient was discharged.Although the precise mechanism is not fully understood, DKA has been reported to be rarely complicated by hypothermia due to impaired glucose utilization. To our knowledge, no previous reports have described a case of SGLT2I-induced DKA complicated by hypothermia. Given its rarity, we report this case along with a literature review.In conclusion, we present a rare case of SGLT2I-induced DKA accompanied by hypothermia. To the best of our knowledge, no such cases have been previously reported. Presentation: Monday, July 14, 2025