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SGLT-2 inhibitor associated euglycaemic diabetic ketoacidosis in an orthopaedic trauma patient
  1. Duncan Taylor Ritchie1,2 and
  2. James Dixon1
  1. 1Department of Trauma and Orthopaedic Surgery, NHS Grampian, Aberdeen, UK
  2. 2School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Duncan Taylor Ritchie; duncan.ritchie{at}


Euglycaemic diabetic ketoacidosis is a serious but rare adverse effect of treatment with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. A man in his 60s with type 2 diabetes mellitus underwent total hip replacement for an intracapsular neck of femur fracture. His SGLT-2 inhibitor was continued perioperatively and blood glucose levels were normal throughout the admission. A diagnosis of severe euglycaemic diabetic ketoacidosis was made in the operating theatre which required treatment in a critical care unit. This resulted in increased morbidity due to decreased postoperative mobilisation and a new requirement for subcutaneous insulin. This case highlights the need for withholding SGLT-2 inhibitors in patients admitted for emergency surgery and a need for regular ketone monitoring in these patients, even in the context of normoglycaemia.

  • Unwanted effects / adverse reactions
  • Orthopaedics
  • Perioperative care
  • Diabetes

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  • Contributors DTR: planning, literature review, manuscript writing and editing. JD: planning and manuscript editing.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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