Euglycemic ketoacidosis in a non-diabetic patient with Duchenne muscular dystrophy on dapagliflozin.

IF 3.8 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Internal and Emergency Medicine Pub Date : 2025-09-01 DOI:10.1007/s11739-025-04058-3

Ana María Gutiérrez-Baena, Mariona Tegido Mateu, Paula Álvarez Schlegel, Sandra Clotet-Vidal

{"title":"Euglycemic ketoacidosis in a non-diabetic patient with Duchenne muscular dystrophy on dapagliflozin.","authors":"Ana María Gutiérrez-Baena, Mariona Tegido Mateu, Paula Álvarez Schlegel, Sandra Clotet-Vidal","doi":"10.1007/s11739-025-04058-3","DOIUrl":null,"url":null,"abstract":"<p><p>Euglycemic ketoacidosis (EKA) is an uncommon but potentially life-threatening condition characterized by ketoacidosis with normal or mildly elevated blood glucose levels. We report the case of a 24-year-old male with advanced Duchenne muscular dystrophy and cardiomyopathy treated with dapagliflozin, who developed EKA triggered by reduced food intake due to dysphagia and delayed intestinal motility. The patient presented with metabolic acidosis and elevated ketones but maintained normal glucose levels. Discontinuation of dapagliflozin, along with intravenous bicarbonate and dextrose administration, led to clinical and biochemical resolution without the need for insulin therapy. This case highlights the importance of recognizing SGLT2 inhibitor-associated EKA in non-diabetic patients, especially during fasting or stress conditions, to prevent misdiagnosis and ensure prompt management. Increased clinical vigilance and patient education are essential given the expanding use of these agents in non-diabetic populations.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1865-1867"},"PeriodicalIF":3.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476399/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal and Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11739-025-04058-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Euglycemic ketoacidosis (EKA) is an uncommon but potentially life-threatening condition characterized by ketoacidosis with normal or mildly elevated blood glucose levels. We report the case of a 24-year-old male with advanced Duchenne muscular dystrophy and cardiomyopathy treated with dapagliflozin, who developed EKA triggered by reduced food intake due to dysphagia and delayed intestinal motility. The patient presented with metabolic acidosis and elevated ketones but maintained normal glucose levels. Discontinuation of dapagliflozin, along with intravenous bicarbonate and dextrose administration, led to clinical and biochemical resolution without the need for insulin therapy. This case highlights the importance of recognizing SGLT2 inhibitor-associated EKA in non-diabetic patients, especially during fasting or stress conditions, to prevent misdiagnosis and ensure prompt management. Increased clinical vigilance and patient education are essential given the expanding use of these agents in non-diabetic populations.

查看原文本刊更多论文

应用达格列净治疗杜氏肌营养不良的非糖尿病患者的正糖酮症酸中毒。

正常血糖酮症酸中毒（EKA）是一种罕见但可能危及生命的疾病，其特征是酮症酸中毒伴正常或轻度血糖升高。我们报告一名24岁的男性，患有晚期杜氏肌营养不良和心肌病，接受达格列净治疗，因吞咽困难和肠道运动延迟导致食物摄入减少而发生EKA。患者表现为代谢性酸中毒和酮类升高，但血糖维持正常。停用达格列净，同时静脉注射碳酸氢盐和葡萄糖，导致临床和生化解决，无需胰岛素治疗。该病例强调了在非糖尿病患者中识别SGLT2抑制剂相关EKA的重要性，特别是在禁食或应激状态下，以防止误诊并确保及时处理。鉴于这些药物在非糖尿病人群中的使用日益扩大，提高临床警惕性和患者教育是必不可少的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Internal and Emergency Medicine 医学-医学：内科

CiteScore

7.20

自引率

4.30%

发文量

258

审稿时长

6-12 weeks

期刊介绍： Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.