Abstract

Euglycemic diabetic ketoacidosis (eDKA) is a rare but life-threatening condition that can occur in patients taking sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly under conditions of metabolic stress, such as fasting. We report the case of a 45-year-old male with type 2 diabetes who presented to the emergency department with symptoms of nausea, vomiting, and tachypnea following prolonged fasting during a religious observance. Despite normal blood glucose levels, he was diagnosed with eDKA, likely triggered by the combined effects of fasting and SGLT2 inhibitor therapy. This case underscores the importance of considering eDKA in patients on SGLT2 inhibitors, even with normal glucose levels, particularly during periods of fasting or metabolic stress. The management of eDKA follows the principles of traditional diabetic ketoacidosis treatment, including insulin infusion, fluid resuscitation, and electrolyte correction. Awareness of this rare complication is crucial for emergency physicians to ensure timely diagnosis and intervention.

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