Euglycemic diabetic ketoacidosis after the initiation of dulaglutide in patient with type 2 diabetes.

RATIONALE

Diabetic ketoacidosis is rarely observed when the blood glucose level is <250 mg/dL. This is referred to as euglycemic diabetic ketoacidosis (EDKA). EDKA can present diagnostic and management challenges for physicians, especially when dealing with unusual triggers such as glucagon-like peptide 1 (GLP1) receptor agonists and sodium-glucose co-transporter 2 inhibitors. With this case report, we wanted to raise the knowledge and understanding of EDKA and its triggering factors.

PATIENT CONCERNS

A 45-year-old man was admitted to hospital for epigastric pain, loss of appetite, and vomiting 3 days after the initiation of dulaglutide. The results of laboratory examination showed EDKA.

DIAGNOSES

The patient was diagnosed with EDKA after the initiation of GLP1 receptor agonists.

INTERVENTIONS

Intravenous fluid and insulin infusion were immediately started.

OUTCOME

The patient was discharged after treatment.

LESSONS

In this case report describes the use of GLP1 receptor agonists along with Sodium-glucose co-transporter 2 inhibitors in type 2 diabetes patients whose extreme restriction of carbohydrate intake may have triggered EDKA. Therefore, physicians should use diabetes medications in a stepwise manner and advise their patients not to over-restrict their carbohydrate intake while they are being treated with GLP1 receptor agonists.