Euglycemic diabetic ketoacidosis caused by canagliflozin: A rare case report

Drugs are one of the rare precipitating factors for diabetic ketoacidosis (DKA) in diabetes mellitus. Medications causing DKA are corticosteroids, pentamidine, clozapine, etc. Even rare is for an oral hypoglycemic agent to cause DKA, but since the approval of the first-in-class drug in 2013, data have emerged suggesting that sodium glucose transporter-2 inhibitors, including canagliflozin, may lead to DKA. This is a case of a 46-year-old male patient who was admitted to the intensive care unit with signs and symptoms suggestive of DKA. He was recently started on canagliflozin. He had a blood glucose level of 243 mg/dl, urine was positive for ketones, and his arterial blood gas was suggestive of high anion gap metabolic acidosis. All the precipitating causes of DKA were ruled out. Based on the above findings and laboratory results, the possibility of canagliflozin-induced ketoacidosis was kept and managed on the lines of DKA.