Sodium-glucose cotransporter-2 inhibitors induced euglycemic diabetic ketoacidosis: Two case reports and a review of the literature.

If not detected early, euglycemic diabetic ketoacidosis can be a serious adverse effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors. Unfortunately, euglycemic diabetic ketoacidosis is underreported in recent trials and missed because of normal blood sugar levels and nonspecific symptoms on presentation. We present two patients with type 2 diabetes mellitus who developed dapagliflozin-associated euglycemic diabetic ketoacidosis followed by hyperglycemic ketoacidosis. The second patient had euglycemic ketoacidosis twice despite instructions to stop using the medication dapagliflozin.