Euglycemic diabetic ketoacidosis associated
with a sodium-glucose co transporter 2
inhibitor use in a trauma patient: a case report

Euglycemic diabetic ketoacidosis associated
with a sodium-glucose co transporter 2
inhibitor use in a trauma patient: a case report

Trauma, Euglycemic diabetic ketoacidosis, Sodium-glucose co transporter 2 inhibitors, Sepsis shock

Abstract
Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i), like empagliflozin, are widely prescribed for
managing type 2 diabetes mellitus. However, they carry a rare but serious risk: euglycemic diabetic ketoacidosis
(EDKA). EDKA’s atypical presentation, characterized by metabolic acidosis and ketosis despite normal blood glucose
levels, often delays diagnosis, posing significant challenges in intensive care.
Case presentation We report the case of a 74-year-old female with type 2 diabetes on empagliflozin, gliclazide, and
metformin. Admitted after severe trauma from a road traffic accident, she subsequently developed EDKA. This was
fostered by septic shock due to methicillin-susceptible Staphylococcus aureus cellulitis. All home medications were
discontinued. EDKA was successfully managed with fluid volume expansion, continuous intravenous insulin and
dextrose infusions, resolving her metabolic derangements within five days.
Conclusion SGLT2i use is associated with a significantly increased risk of EDKA. Early diagnosis is critical due to its
potential lethal consequences. Reintroducing SGLT2i in ICU patients, especially trauma patients at high sepsis risk,
requires careful, daily reassessment given their unpredictable clinical course.
Keywords Trauma, Euglycemic diabetic ketoacidosis, Sodium-glucose co transporter 2 inhibitors, Sepsis shock

Ophélie Dirand1

, Julie Dupont1

, Emmanuel Weiss1,2 and Myriam Lamamri1*

2025

Peri Irawan

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