• Chie Kitahara, Shuhei Morita, Shohei Kishimoto, Shohei Matsuno, Shinsuke Uraki, Ken Takeshima, Yasushi Furukawa, Hidefumi Inaba, Hiroshi Iwakura, Hiroyuki Ariyasu, Hiroto Furuta, Masahiro Nishi, and Takashi Akamizu.
• The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.
• J Diabetes Investig. 2021 Apr 1; 12 (4): 664-667.

AbstractWe report the first case of intraoperatively detected euglycemic diabetic ketoacidosis (DKA) associated with sodium-glucose cotransporter 2 inhibitors during thoracic surgery. A 59-year-old man had a 12-year history of type 2 diabetes mellitus treated with insulin and empagliflozin. The patient developed bacterial empyema and was initiated with antibiotics at a local hospital. Owing to the persistence of his symptoms, he was transferred to our hospital after the medication of empagliflozin the day before surgery. After overnight fasting, the patient underwent thoracoscopic debridement and intrathoracic lavage surgery. During this surgery, he was noted to have euglycemic ketosis and acidosis, and diagnosed as euglycemic DKA. Immediately after the consultation in our department, the patient underwent treatment for DKA. He awoke from anesthesia normally and showed no symptoms of DKA. DKA gradually resolved over the next 24 h. Early identification and management are critical for rapid recovery from perioperative euglycemic DKA associated with sodium-glucose cotransporter 2 inhibitors, especially during thoracic surgery.© 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

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