Evidence mapPaperPMID 41473701Full record

ArticlePCN reports : psychiatry and clinical neurosciences2025

Stereotypical diagnostic bias for alcohol-induced ketoacidosis could lead to death: Normal blood sugar levels in SGLT2 blocker-induced severe diabetic ketoacidosis.

Shun Kudo, Sho Endo, Yurina Nanahara, Takao Katahira, Masayoshi Makio, Mikiko Yamauchi, Satoyuki Ogino, Akihiro Koreki, Takuto Ishida, Hiroyuki Uchida and 3 more

Abstract read
In one paragraph

Article in PCN reports : psychiatry and clinical neurosciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Shun KudoDepartment of Psychiatry Saitama City Hospital Saitama Japan.ORCID https://orcid.org/0000-0003-3570-9186
Sho EndoDepartment of Internal Medicine Saitama City Hospital Saitama Japan.
Yurina NanaharaDepartment of Internal Medicine Saitama City Hospital Saitama Japan.
Takao KatahiraDepartment of Internal Medicine Saitama City Hospital Saitama Japan.
Masayoshi MakioDepartment of Internal Medicine Saitama City Hospital Saitama Japan.
Mikiko YamauchiDepartment of Psychiatry Saitama City Hospital Saitama Japan.
Satoyuki OginoDepartment of Neuropsychiatry Keio University School of Medicine Tokyo Japan.
Akihiro KorekiDepartment of Neuropsychiatry Keio University School of Medicine Tokyo Japan.
Takuto IshidaDepartment of Neuropsychiatry Keio University School of Medicine Tokyo Japan.
Hiroyuki UchidaDepartment of Neuropsychiatry Keio University School of Medicine Tokyo Japan.
Masaru MimuraDepartment of Neuropsychiatry Keio University School of Medicine Tokyo Japan.
Michitaka FunayamaDepartment of Neuropsychiatry Keio University School of Medicine Tokyo Japan.
Yasushi NemotoDepartment of Psychiatry Saitama City Hospital Saitama Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Ketoacidosis, a life-threatening disease, can be caused by diabetes, alcohol consumption, and severe malnutrition, which are not uncommon in psychiatry. Diabetic and alcoholic ketoacidosis (AKA) are particularly frequent, and differentiating between these two is essential in terms of the substantially different treatment interventions. In recent years, the advent of sodium-glucose co-transporter 2 (SGLT2) inhibitors has made this distinction more difficult, mainly due to the increase in euglycemic diabetic ketoacidosis (euDKA)-ketoacidosis in normal or near-normal blood sugar levels-in the presence of SGLT2 inhibitors. Case Presentation: We describe a 52-year-old man's case of severe euDKA caused by an SGLT2 inhibitor with alcohol use disorder. We initially suspected mainly AKA due to his mild disturbance of consciousness, habitual high intake of alcohol, and almost normal blood glucose level (142 mg/dL). We administered supplemental fluids and vitamin B complex instead of insulin, which is needed for euDKA, but his disorientation and metabolic acidosis worsened. Upon recognizing his inadequate response to fluid replacement and considering his history of SGLT2 inhibitor use, we identified euDKA as the primary pathology. Implementing continuous insulin therapy and tight glycemic control resulted in a rapid improvement in the patient's condition. Conclusion: Even with normal or near-normal blood sugar levels in a patient with suspected AKA, missing the possibility of euDKA can be fatal. Therefore, psychiatrists should remain vigilant for euDKA, especially in patients using SGLT2 inhibitors, by conducting frequent blood gas examinations.

Indexed as

alcoholic ketoacidosisdiabeteseuglycemic diabetic ketoacidosisinsulinSGLT2 inhibitor

Identifiers

PMID41473701
PMCPMC12745889

What Socratic holds

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