Background: Type 2 diabetes (T2DM) is becoming more prevalent worldwide and sodium-glucose co-transporter-2 (SGLT2) inhibitors are being increasingly used in its management. However, they have been associated with the serious complication of euglycemic diabetic ketoacidosis (EDKA). Case Presentation: A 51-year-old female on canagliflozin for T2DM presented with a 2-week history of vomiting and abdominal pain. With a blood glucose of 9.0 mmol/l, a diagnosis of diabetic ketoacidosis was at first overlooked and the patient was initially managed for pyelonephritis. However, a diagnosis of EDKA was subsequently reached on day 3 after a blood gas revealed a high anion gap metabolic acidosis with ketones of 3.9 mmol/l. Conclusion: This case demonstrates the diagnostic challenge posed by the atypical presentation of SGLT2 inhibitor-associated EDKA. Furthermore, it underlines the need for patient education concerning stopping these medications during illness and highlights how their association with urinary tract infections may further increase the risk of EDKA.

Keywords: Case report; diabetes; SGLT2 inhibitors; euglycemic diabetic ketoacidosis; medication related complication