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Peer-reviewedCC BYCase reports in critical care

Euglycemic SGLT2 Inhibitor-Associated Ketoacidosis in a Nondiabetic Patient: A Case Report.

  • Carmelo Zinnato1
  • Teresa Roatta2
  • Giacomo Berta1
  • Roberto Penso1
  • Vincenzo Russotto1,3
  1. 1Department of Anesthesia and Critical Care University Hospital San Luigi Gonzaga University of Turin Turin Italy unito.it.
  2. 2Department of Surgical Sciences University of Turin Turin Italy unito.it.
  3. 3Department of Oncology University of Turin Turin Italy unito.it.
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Abstract

We present the case of a 62-year-old nondiabetic woman receiving dapagliflozin for dilated cardiomyopathy presenting to the emergency department with severe hypoxemic respiratory failure because of suspected cardiogenic pulmonary edema. Despite treatment, she remained symptomatic and required intubation and intensive care admission. After intubation, high-anion-gap metabolic acidosis was unmasked. After exclusion of other common causes, SGLT2 inhibitor-associated ketoacidosis due to dapagliflozin was suspected. Marked ketonuria confirmed the diagnosis despite the absence of hyperglycemia. Dapagliflozin was discontinued, and intravenous insulin, glucose infusion, and early enteral nutrition were initiated. Metabolic acidosis resolved completely within 24 h. The patient was successfully extubated and discharged from the intensive care unit 48 h later. SGLT2 inhibitor-associated ketoacidosis should be considered in patients receiving sodium-glucose cotransporter-2 inhibitors who develop otherwise unexplained high-anion-gap metabolic acidosis, irrespective of diabetic status or blood glucose concentration. Fasting and acute illness are relevant precipitating factors; prompt drug withdrawal, carbohydrate administration, insulin therapy, and nutritional support can lead to rapid resolution.

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Cite

BibTeXRIS
BibTeX
@article{zinnato2026euglycemic,
  title = {{Euglycemic SGLT2 Inhibitor-Associated Ketoacidosis in a Nondiabetic Patient: A Case Report.}},
  author = {Carmelo Zinnato and Teresa Roatta and Giacomo Berta and Roberto Penso and Vincenzo Russotto},
  journal = {Case reports in critical care},
  year = {2026},
  month = oct,
  doi = {10.1155/crcc/3970190},
  url = {https://europepmc.org/article/MED/42928725},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Euglycemic SGLT2 Inhibitor-Associated Ketoacidosis in a Nondiabetic Patient: A Case Report.
AU  - Carmelo Zinnato
AU  - Teresa Roatta
AU  - Giacomo Berta
AU  - Roberto Penso
AU  - Vincenzo Russotto
PY  - 2026
DA  - 2026/10/25
JO  - Case reports in critical care
DO  - 10.1155/crcc/3970190
UR  - https://europepmc.org/article/MED/42928725
AB  - We present the case of a 62-year-old nondiabetic woman receiving dapagliflozin for dilated cardiomyopathy presenting to the emergency department with severe hypoxemic respiratory failure because of suspected cardiogenic pulmonary edema. Despite treatment, she remained symptomatic and required intubation and intensive care admission. After intubation, high-anion-gap metabolic acidosis was unmasked. After exclusion of other common causes, SGLT2 inhibitor-associated ketoacidosis due to dapagliflozin was suspected. Marked ketonuria confirmed the diagnosis despite the absence of hyperglycemia. Dapagliflozin was discontinued, and intravenous insulin, glucose infusion, and early enteral nutrition were initiated. Metabolic acidosis resolved completely within 24 h. The patient was successfully extubated and discharged from the intensive care unit 48 h later. SGLT2 inhibitor-associated ketoacidosis should be considered in patients receiving sodium-glucose cotransporter-2 inhibitors who develop otherwise unexplained high-anion-gap metabolic acidosis, irrespective of diabetic status or blood glucose concentration. Fasting and acute illness are relevant precipitating factors; prompt drug withdrawal, carbohydrate administration, insulin therapy, and nutritional support can lead to rapid resolution.
SN  - 2090-6420
SN  - 2090-6439
ER  -