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Case report
Prolonged euglycemic diabetic ketoacidosis triggered by a single dose of sodium–glucose cotransporter 2 inhibitor
  1. Maki Miwa,
  2. Mikio Nakajima,
  3. Richard H Kaszynski and
  4. Hideaki Goto
  1. Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Shibuya-ku, Tokyo, Japan
  1. Correspondence to Dr Maki Miwa; cucumber_cetriolo{at}


A 45-year-old woman was admitted for diabetic ketoacidosis (DKA). Aggressive rehydration and continuous intravenous insulin resulted in improved blood glucose levels; however, metabolic acidosis persisted. One day prior to admission, the patient took a single dose of a sodium–glucose cotransporter 2 (SGLT2) inhibitor and this likely contributed to the prolonged euglycemic DKA. A single dose of this drug remained effective for over 100 hours as evidenced by massive excretion of urine glucose continuing long after blood glucose normalisation. SGLT2 inhibitor use should be refrained in cases in which DKA has already occurred as they may result in increasing severity or prolonged DKA.

  • diabetes
  • drugs: endocrine system
  • primary care

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  • Contributors MM and MN contributed to the planning, data gathering, literature review, writing and editing the article. RHK and HG provided professional suggestions in the conduct of the study. All authors commented on draft versions and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.