SGLT2i-induced euglycemic diabetic ketoacidosis in a heart failure patient with acute myocardial infarction: a case report.

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are widely used as oral hypoglycemic agents in type 2 diabetes mellitus (T2DM) patients because of their cardiovascular and renal benefits. Euglycemic diabetic ketoacidosis (euDKA) is a serious and increasingly recognized complication of SGLT2i therapy. The atypical symptoms of euDKA may lead to delayed diagnosis and life-threatening outcomes. Case Presentation: Here, we report a 48-year-old woman with T2DM and hypertension who was diagnosed with acute myocardial infarction (AMI). The patient underwent emergency percutaneous coronary intervention and received canagliflozin for heart failure. However, the patient presented with tachypnea, dyspnea, nausea, vomiting, and abdominal pain during the postoperative period. SGLT2i-associated euDKA was suspected to be the underlying cause of mild hyperglycemia, high anion gap metabolic acidosis, and ketonemia. The patient was successfully rescued by rapid correction of dehydration and electrolyte abnormalities and an insulin drip to normalize acidosis and bicarbonate levels. Discussion and Conclusion: Although the early use of SGLT2i may improve cardiac function in patients with AMI and heart failure, our findings suggest that clinicians should be aware of the association between SGLT2i therapy and euDKA. SGLT2i should be avoided in acute cardiovascular crises until patient stabilization.