Case Report: Chest Pain as an Uncommon Presentation for Euglycemic Diabetic Ketoacidosis in a Female Patient Using SGLT2 inhibitor

Abstract

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are well-recognised antidiabetic medications among clinicians due to its highly protective effects on cardiovascular and renal systems on diabetic patients. However, one of its uncommonly reported side effects is the development of euglycemic diabetic ketoacidosis (EuDKA) which is characterized by mild hyperglycemia, ketosis and acidosis. Chest pain as a clinical presentation of EuDKA has been rarely reported in the literature. We present a case of a 46-year-old female with a past medical history of type 2 diabetes mellitus (T2DM), hypertension, and hypertriglyceridemia presented to the hospital with central chest pain that radiates to the back and is associated with mild shortness of breath and one bout of vomiting. She had been taking dapagliflozin, an SGLT2 inhibitor, for four years. She was found to have a blood glucose level of 7 mmol\L, high anion gap metabolic acidosis and ketonuria. Toxicology screening was unremarkable. She was diagnosed as a case of SGLT2-induced EuDKA and was treated with fluid, insulin and potassium chloride (KCL). Her hospital course went smoothly. Dapagloflzi was discontinued, and she was discharged home on oral metformin and subcutaneous insulin. This study highlights the rare occurance of chest pain as a presentation of EuDKA, an uncommon side effect of the widely used SGLT2 inhibitors. Chest pain in patients using SGLT2 Inhibitors should raise the clinician's suspicion for possible EuDKA.