COVID-19 Precipitating Euglycaemic Diabetic Ketoacidosis with SGLT2 Inhibitor Use.

OBJECTIVE: To describe a patient who developed euglycaemic diabetic ketoacidosis (DKA) in the setting of SGLT2 inhibitor use precipitated by COVID-19. PATIENT AND METHODS: A 52-year-old male with type II diabetes on empagliflozin and no history of DKA presented with symptoms of COVID-19 as well as laboratory findings consistent with euglycaemic DKA. His hospital course was complicated by recurrent episodes of euglycaemic DKA as well as hyperglycaemic DKA.
CONCLUSION: SGLT2 inhibitors should be held as early as possible in COVID-19 cases due to the risk of euglycaemic DKA. These patients should also have more intense glucose monitoring. LEARNING POINTS: COVID-19 can precipitate euglycaemic DKA in diabetic patients taking SGLT2 inhibitors.Clinicians should be cognizant that the effects of SGLT2 inhibitors can persist for more than 72 hours after the last dose.Diabetic patients with COVID-19 require closer strict glucose monitoring to reduce the risk of DKA. © EFIM 2020.