부산대학교 도서관

The patient was a 58-year-old woman with type 2 diabetes and obesity medicated by an SGLT2 inhibitor and biguanide. She had no medical history of diabetic ketoacidosis. She visited our emergency room with upper abdominal pain, vomiting, and diarrhea for four days despite discontinuing all oral hypoglycemic agents. Emergency upper gastrointestinal endoscopy revealed acute duodenitis. Blood and urine tests revealed that her blood glucose level was 211 mg/dL, HbA1c 8.2 %, urine ketone bodies (3+), and venous blood gas pH 7.291, indicating euglycemic DKA during treatment with an SGLT2 inhibitor. As both islet-related and thyroid-related auto-antibodies were positive, she was finally diagnosed with SPIDDM with Graves' disease. In this case, euglycemic DKA seems to have been caused by four factors: insufficient carbohydrate intake due to acute duodenitis, potential insulin insufficiencies due to SPIDDM, accelerated fat catabolism due to hyperthyroidism, and oral intake of an SGLT2 inhibitor.