امرأة عمرها ٥٤ سنة مصابة بالسكري، تأخذ إمباغليفلوزين. بعد عملية في البطن صامت يومين، وصار عندها غثيان وقيء وتنفس سريع وألم بطن. السكر ١٩٨ فقط، لكن الكيتونات مرتفعة والـpH ٧٫١٨. ما التشخيص الأرجح؟

A 54-year-old diabetic woman on empagliflozin fasted for two days after abdominal surgery and now has nausea, vomiting, rapid breathing and abdominal pain. Glucose is only 198 but ketones are high and pH 7.18. What is the likely diagnosis?

1. Metabolic alkalosis from repeated vomiting
2. Euglycaemic ketoacidosis linked to SGLT2 inhibitors
3. Mild dehydration needing oral water only
4. Mild post-operative pancreatitis only

Answer: B) Euglycaemic ketoacidosis linked to SGLT2 inhibitors. SGLT2 inhibitors can cause ketoacidosis with only modestly raised glucose, especially with fasting and surgery, so they are stopped days before operations and during illness.