Euglycemic DKA in a Surgical Patient on SGLT2i: The Importance of Preoperative Medication Review
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-9-2025
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are an emerging class of oral medications for blood glucose management in type 2 diabetes (DM2). These drugs inhibit the SGLT2 transporter in the proximal tubule, responsible for ~90% of urinary glucose reabsorption. While effective, SGLT2i carry a rare but serious risk of life-threatening euglycemic diabetic ketoacidosis (euDKA). This condition is characterized by metabolic acidosis (pH <7.3, bicarbonate <18 mEq/L), an elevated anion gap, and ketones in blood/urine, all with normal or near-normal glucose <250 mg/dL. euDKA presents with nonspecific symptoms and is easily overlooked, particularly perioperatively. The ACC recommends stopping SGLT2i ≥3 days pre-op. Diagnosis requires serum/urine ketones, pH, bicarbonate, anion gap, and electrolytes. Treatment includes drug discontinuation, IV fluids with dextrose, insulin infusion, and K+.
Recommended Citation
Phillips A, Neal J, Watson N. Euglycemic DKA in a surgical patient on SGLT2i: the importance of preoperative medication review. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1744