How to manage a severe form of euglycemic diabetic ketoacidosis caused by SGLT2 inhibitors: a case report and literature review

The use of sodium-glucose cotransporter-2 inhibitors is becoming increasingly widespread not only for the treatment of diabetes mellitus, but also for heart failure and kidney disease. However, these medications can lead to very severe complications, sometimes even fatal, such as Euglycemic Ketoacidosis (EDKA). In this report, we present the case of a 79-year-old woman, affected by type 2 diabetes mellitus on insulin therapy and empagliflozin, who was admitted to our emergency department for a severe EDKA. Treatment with bicarbonates did not improve her condition worsening the hypokalaemia and complicating the administration of insulin. For this reason, we decided to administer octreotide subcutaneously with a rapid resolution of EDKA and an improvement in clinical conditions, demonstrating that octreotide can be an excellent therapeutic option for EDKA. Starting from our experience, we conducted a review of the relevant literature on this issue.