8084 Euglycemic Diabetic Ketoacidosis in Vulnerable Populations: A Case Series

Disclosure: M.S. Shah: None. S. Humayon: None. R. Chawla: None. C. Peñaherrera: None. This case series explores seven cases admitted to a community hospital's inpatient and ICU services in 2023, with resident physicians closely managing their care. Our focus was to compare presentations and highlight risk factors contributing to Euglycemic Diabetic Ketoacidosis (euDKA). The following seven patients have a history of type 2 diabetes mellitus (DM 2) and were on SGLT-2 inhibitors for either diabetic management or goal-directed medical therapy (GDMT) for heart failure. These patients either presented with or developed euDKA during hospitalization. Diagnostic criteria used for euDKA being HCO3 (< 18 mEq/L) or arterial pH (< 7.3 pH units), with a normal or mildly elevated blood glucose (> 250 mg/dL) and Beta-hydroxybutyrate (>3 mmol/L). All patients were treated with an insulin drip. IV fluids were provided cautiously given multiple patients with reduced ejection fraction and lack of severe dehydration seen in euDKA. Mrs. E, a 57-year-old female with DM 2 (HbA1c of 9.7%), presented to the hospital for ST elevation M.I and subsequently started on GDMT for heart failure. Initiated on Dapagliflozin inpatient, leading to euDKA amid poor oral intake. Mr. L, a 54-year-old male with DM 2 presented to the ED with hyponatremia. On Empagliflozin per GDMT for heart failure. He presented with euDKA, attributed to prolonged fasting from chronic nausea. Hospital course complicated by cardiac arrest and AKI on CKD requiring CRRT. Mr. S, a 56-year-old male with DM 2 (HbA1c of 7.7%), on Dapagliflozin. The patient was in euDKA on presentation to the hospital. The precipitating event included nausea and abdominal pain aggravated by food, leading to poor PO intake for 3 days prior to arrival to ED. Mr. L, an 86-year-old male with DM 2 and heart failure, on Empagliflozin per GDMT guidelines. EuDKA ensued due to starvation in the setting of failure to thrive and generalized weakness. Mr. A, an 81-year-old male with DM 2 on Empagliflozin. EuDKA manifested post fall leading to a prolonged period of caloric deprivation. Mr. G, a 74-year-old male with DM 2 and dementia, started on Dapagliflozin. EuDKA occurred following a period of starvation. Mr. Q, a 66-year-old male with DM 2 on insulin pump, heart failure and metastatic pancreatic cancer undergoing chemotherapy. Patient was on Empagliflozin per GDMT for heart failure. Starvation occurred due to PEG tube malfunction inciting euDKA. These cases confirm that starvation can raise the risk for EuDKA. Further research is essential to refine risk stratification and preventive strategies in this subset of patients. It would be ideal to hold SGLT-2 inhibitors inpatient if providers anticipate prolonged fasting or caloric restrictions. Educating patients on avoiding erratic eating habits is crucial to mitigate euDKA. Recognizing risks is vital in patient selection and counseling. Presentation: 6/2/2024