A 72-Year-Old Woman with Altered Mental Status and Acidemia

This case study describes a 72-year-old woman with a complex medical history, including bladder cancer, type 2 diabetes, and chronic kidney disease, who was admitted with altered mental status and acidemia. Her clinical course involved multiple comorbidities, progressive shock, and diagnostic challenges surrounding high anion gap metabolic acidosis. Ultimately, the diagnosis of euglycemic diabetic ketoacidosis (EDKA), likely triggered by dapagliflozin in the perioperative state, was confirmed via elevated β-hydroxybutyrate levels. The case highlights diagnostic strategies, management complexities, and the implications of SGLT2 inhibitors in acute metabolic emergencies.

This case study describes a 72-year-old woman with a complex medical history, including bladder cancer, type 2 diabetes, and chronic kidney disease, who was admitted with altered mental status and acidemia. Her clinical course involved multiple comorbidities, progressive shock, and diagnostic challenges surrounding high anion gap metabolic acidosis. Ultimately, the diagnosis of euglycemic diabetic ketoacidosis (EDKA), likely triggered by dapagliflozin in the perioperative state, was confirmed via elevated β-hydroxybutyrate levels. The case highlights diagnostic strategies, management complexities, and the implications of SGLT2 inhibitors in acute metabolic emergencies.