Euglycemic Diabetic Ketoacidosis Associated with Empagliflozin Use in the Course of the SARS-Cov-2 Pandemic

Sodium glucose cotransporter 2 (SGLT2) inhibitors are among the new generation oral anti-diabetic drugs that have started to be used in the treatment of type 2 diabetes mellitus. Although these drugs are highly beneficial, life-threatening side effects such as euglycemic diabetic ketoacidosis (eDKA) are reported with their use. In eDKA, metabolic acidosis and anion gap appear in blood gases and serum glucose in less than 200 mg/dl. This can delay diagnosis and treatment. In our case, a 42-year female presented to the Emergency Room with nausea and vomiting. It was observed that the patient had been using empagliflozin for a year. Her blood gas analyses and laboratory tests showed metabolic acidosis and ketosis. The patient was initially suspected to be a case of coronavirus disease-2019 (COVID-19) complicating the course of diabetes, finally it was diagnosed as a case of eDKA due to empagliflozin use. We noticed that during the current pandemic, some other diagnoses can be missed or their diagnosis can be delayed.