Sodium-glucose co-transporter-2 inhibitor-associated non-diabetic ketoacidosis: a case report

Ketoacidosis is considered an emergency metabolic disorder that can be triggered by starvation and alcohol consumption in addition to diabetes. We described an unusual case of ketoacidosis in a non-diabetic young man who presented to our hospital with a complaint of rapid and shallow breathing, weakness and nausea. Fourteen days back, due to heart failure, he started sodiumglucose co-transporter 2 inhibitors (SGLT2-i) in addition to fumarate bisoprolol, sacubitril/valsartan and eplerenone. Based on clinical examination, ketoacidosis was suspected, although his glucose and glycosylated hemoglobin levels were in range. Overall, based on the clinical and laboratory findings, the diagnosis of euglycemic non-diabetic ketoacidosis due to the use of the SGLT2-i was made and SGLT2-i has been discontinued. Although SGLT2-i are effective and safe drugs, it is advisable to carefully evaluate their use also in non-diabetic patients especially when hepatic fibrosis or incorrect eating habits are present.