A Cautionary Case of SGLT-2 Inhibitor-Induced Euglycemic Diabetic Ketoacidosis in a Patient with Foreseeable Risk Factors

Background: Euglycemic Diabetic Ketoacidosis (EDKA) is a rare but well-known adverse effect of sodium glucose transporter 2 (SGLT-2) inhibitors. This class of antidiabetic medications has ketogenic properties that predispose patients to develop EDKA, especially in the setting of intercurrent illnesses, major surgeries, increased alcohol intake, reduced insulin dosing, dehydration and reductions in carbohydrate intake. Case Presentation: A 68-year-old female with newly diagnosed metastatic adrenocortical carcinoma and adrenal insufficiency (AI) developed EDKA after palliative debulking that required ICU admission and intubation after being prescribed dapagliflozin by her outpatient provider. Conclusions: Healthcare providers must assess patient risk factors for developing EDKA prior to prescribing SGLT-2 inhibitors. This assessment requires an understanding of the inherent downstream metabolic effects of SGLT-2 inhibitor-induced glycosuria.