Fanconi syndrome and euglycemic diabetic ketoacidosis secondary to canagliflozin use in a type 2 diabetic

Use of sodium glucose cotransporter 2 (SGLT2) inhibitors is increasing for management of type 2 diabetes, congestive heart failure, and chronic kidney disease. A rare but serious adverse effect of SGLT2 inhibitors is drug-induced Fanconi syndrome, believed to be due to iatrogenic damage at proximal convoluted tubule. Additionally, SGLT2 inhibitors have been known to cause euglycemic diabetic ketoacidosis (DKA). The following report describes a case in which a 35-year-old female with a history of type two diabetes developed concomitant drug-induced Fanconi Syndrome and euglycemic DKA secondary to canagliflozin use. As use of SGLT2 inhibitors continues to increase, providers should be aware of the complication of drug-induced Fanconi Syndrome, closely monitor the acid-base status and electrolytes of patients who show clinical signs of Fanconi syndrome, and discontinue the use of SGLT2 inhibitors in patients for whom no other cause of Fanconi syndrome is identified.