Sodium Glucose Cotransporter Type 2 Inhibitors (SGLT2i) are oral hypoglycaemic agents that have insulin-independent glucose-lowering mechanism mediated by increasing renal excretion of glucose through inhibition of SGLT2-mediated renal glucose reabsorption. Euglycaemic diabetic ketoacidosis (eDKA) induced by SGLT2i is increasingly recognized side effect. Here, we describe a 26 years old male patient with Type 2 diabetes mellitus (T2DM) and morbid obesity. He was on multiple oral hypoglycaemic agents including SGLT2i. He developed life-threatening severe prolonged eDKA associated with SGLT2i (Canagliflozin) precipitated by adenovirus infection. The acidosis was not responding to standard DKA therapy and renal replacement therapy and was managed effectively with insulin titration based on capillary ketone measurements. We reviewed the literatures for the reported cases of severe prolonged eDKA induced by SGLT2 inhibitors and treatment modalities used.

Sodium Glucose Cotransporter Type 2 Inhibitors (SGLT2i) are oral hypoglycaemic agents that have insulin-independent glucose-lowering mechanism mediated by increasing renal excretion of glucose through inhibition of SGLT2-mediated renal glucose reabsorption. Euglycaemic diabetic ketoacidosis (eDKA) i...