Euglycemic diabetic ketoacidosis associated with etogliflozin in post-pancreatitis diabetes: A case report

BACKGROUND Sodium-glucose cotransporter-2 (SGLT-2) inhibitors improve cardiovascular and renal outcomes in diabetes but may induce euglycemic diabetic ketoacidosis (euDKA) via insulin-independent mechanisms. Post-pancreatitis diabetes mellitus (PPDM) patients with impaired β-cell function face undefined risks with these agents. CASE SUMMARY A 29-year-old man with PPDM developed euDKA 1 week after initiating etogliflozin (5 mg/day). On admission, laboratory tests revealed blood ketones > 4.5 mmol/L, pH 7.1, and glucose 10.78 mmol/L. Discontinuation of SGLT-2 inhibitor, insulin pump therapy (basal 12 U/day, premeal bolus 4 U), aggressive hydration (6000 mL first 2 days), and nutritional support normalized ketosis and acidosis within 24 hours. CONCLUSION Caution is warranted with SGLT-2 inhibitors in PPDM. Insulin therapy is preferred to prevent euDKA.