• Rabia Khalid Alduraibi, Yazeed Mohammed Alrebdi, and Yosef Fahad Altowayan.
• Department of Endocrine and Diabetes, King Fahad Specialist Hospital, Buraydah, Saudi Arabia.
• Medicine (Baltimore). 2023 Jun 9; 102 (23): e34027e34027.

RationaleDiabetic ketoacidosis is rarely observed when the blood glucose level is <250 mg/dL. This is referred to as euglycemic diabetic ketoacidosis (EDKA). EDKA can present diagnostic and management challenges for physicians, especially when dealing with unusual triggers such as glucagon-like peptide 1 (GLP1) receptor agonists and sodium-glucose co-transporter 2 inhibitors. With this case report, we wanted to raise the knowledge and understanding of EDKA and its triggering factors.Patient ConcernsA 45-year-old man was admitted to hospital for epigastric pain, loss of appetite, and vomiting 3 days after the initiation of dulaglutide. The results of laboratory examination showed EDKA.DiagnosesThe patient was diagnosed with EDKA after the initiation of GLP1 receptor agonists.InterventionsIntravenous fluid and insulin infusion were immediately started.OutcomeThe patient was discharged after treatment.LessonsIn this case report describes the use of GLP1 receptor agonists along with Sodium-glucose co-transporter 2 inhibitors in type 2 diabetes patients whose extreme restriction of carbohydrate intake may have triggered EDKA. Therefore, physicians should use diabetes medications in a stepwise manner and advise their patients not to over-restrict their carbohydrate intake while they are being treated with GLP1 receptor agonists.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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