Euglycemic diabetic ketoacidosis associated with sodium–glucose cotransporter-2 inhibitors after surgery: A case report and review of literature

Euglycemic diabetic ketoacidosis is a rare, acute, and life-threatening complication of diabetes mellitus associated with several risk factors such as infection, surgery, pregnancy, fasting, alcohol intake, acute vascular events (acute coronary syndrome or stroke), and the use of sodium–glucose cotransporter 2 (SGLT2) inhibitors. It is characterized by euglycemia, high-anion-gap metabolic acidosis, and ketoacidosis. Herein, we report two patients who used SGLT2 inhibitors before surgery and presented with severe metabolic acidosis after surgery. Subsequently, one patient required intubation, and both patients received two cycles of hemodialysis despite normal renal parameters. This was done to correct the metabolic acidosis, which led to early recovery.