ArticleAME case reports2026
Euglycemic diabetic ketoacidosis with gastrointestinal dysfunction following lung surgery in a patient on SGLT2 inhibitor: a case report.
Article in AME case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are associated with euglycemic diabetic ketoacidosis (EDKA), particularly in the perioperative setting. This report highlights EDKA complicated by postoperative gastrointestinal (GI) dysfunction following lung surgery. Case Description: A 42-year-old woman with type 2 diabetes managed with metformin and empagliflozin (SGLT2i) underwent video-assisted thoracoscopic right upper lobectomy for suspected early lung cancer. Empagliflozin was continued preoperatively. Postoperative day 2, she developed acute dyspnea, right lower abdominal pain (despite normal bowel movements), and tachycardia. Initial arterial blood gas (ABG) revealed severe metabolic acidosis (pH 7.022, HCO Conclusions: Postoperative GI distension in SGLT2i users may signal impending EDKA. Sodium bicarbonate monotherapy provided limited benefit. Successful management requires early recognition, cessation of SGLT2i, adequate caloric intake via dextrose-containing fluids, and insulin to suppress ketogenesis. Preoperative discontinuation of SGLT2i 3-4 days prior to surgery is strongly recommended.
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