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Open Access 14-01-2025 | Encephalopathy | Case Report

Euglycemic diabetic ketoacidosis associated metabolic encephalopathy caused by dapagliflozin: a rare case report

Authors: Lulu Chu, Zhenhua Xi, Runzhi Ma, Weiliang Shi, Guoshen Yu

Published in: BMC Neurology | Issue 1/2025

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Abstract

Background

Sodium–glucose cotransporter-2(SGLT-2) inhibitors are a newer class of antidiabetic drugs with the increased risk of euglycemic diabetic ketoacidosis(EuDKA). Encephalopathy is a rare but life-threatening event of EuDKA. Due to paradoxically normal or slightly elevated serum glucose levels, it’s easy to be mimicked by cerebral infarction, structural brain damage, thus leading to delayed diagnosis and causing seriously irreversible brain injury.

Case presentation

We report severe EuDKA with metabolic encephalopathy secondary to dapagliflozin in a type 2 diabetes mellitus(T2DM) patient.A 72-year-old female was found unconscious 70 minutes ago.Laboratory evaluation revealed a severe metabolic acidosis with an elevated anion gap, and ketones were elevated in the blood and positive in the urine. The patient was eventually diagnosed with metabolic encephalopathy associated with EuDKA and managed accordingly.

Conclusions

Metabolic encephalopathy is a rare but life-threatening complication of EuDKA caused by SGLT-2 inhibitors, the imaging features are similar to those of other metabolic encephalopathy such as poisoning and hypoxia. The precise pathogenesis of encephalopathy in EuDKA remains poorly understood, potentially resulting from the toxic consequences of electrolyte disturbances, ketosis, and acidosis.Testing the level of ketones is essential for unconscious patients who are taking SGLT-2 inhibitors.
Literature
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Metadata
Title
Euglycemic diabetic ketoacidosis associated metabolic encephalopathy caused by dapagliflozin: a rare case report
Authors
Lulu Chu
Zhenhua Xi
Runzhi Ma
Weiliang Shi
Guoshen Yu
Publication date
14-01-2025
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2025
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-025-04027-5

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