Euglycemic Ketoacidosis and an Absence Seizure in A Type 2 Diabetic On SGLT2 Inhibitors: Case Report and Review of the Literature

1. Abstract 1.1. Introduction: In recent years, many new antidiabetic drugs have been developed. One class of these new antidiabetic drugs are sodium-glucose cotransporter 2 inhibitors (SGLT2i). SGLT2i are associated with an increased risk of euglycemic ketoacidosis (euDKA). Case report: We describe an 81-year-old male with type 2 diabetes mellitus (T2DM), who arrived at the emergency department (ED) after a suspected absence seizure. An arterial blood gas (ABG) demonstrated a high anion gap metabolic acidosis. Subsequently, the diagnosis of euDKA was made. A computed tomography (CT) of the brain and electroencephalography (EEG) could not provide a substrate for his seizure. We started with intravenous levetiracetam, an anticonvulsant. He left the hospital in a good condition, 5 days later. Conclusion: Health care professionals should be aware that a patient can be in diabetic ketoacidosis without having elevated levels of blood glucose. Such a euDKA often has a more atypical presentation due to different underlying pathophysiological mechanisms. In animal models, ketonemia exerts anti-seizure effects, but this has yet to be proven in clinical trials. As such, in our patient, a link between his absence seizure and euDKA remains unclear.