Which drug class is known to potentially cause euglycemic ketoacidosis?

Euglycemic ketoacidosis is predominantly associated with SGLT-2 inhibitors, a class of drugs used primarily in the management of type 2 diabetes. These medications work by inhibiting the sodium-glucose co-transporter 2 in the kidneys, leading to increased glucose excretion in the urine. Consequently, they not only help lower blood glucose levels but also have the added effect of promoting weight loss and potentially offering renal protection.

The mechanism behind euglycemic ketoacidosis with SGLT-2 inhibitors involves the low insulin levels that can occur as the body shifts towards utilizing fatty acids for energy when glucose levels are adequately managed. This shift can lead to the production of ketones, even when blood glucose levels remain in the normal range. This is particularly noteworthy because ketoacidosis is typically associated with high blood sugar levels, but in the case of SGLT-2 inhibitors, the risk arises despite euglycemia, making recognition and understanding of this side effect crucial for safe patient management.

Other drug classes listed do not have a significant association with inducing euglycemic ketoacidosis. For instance, biguanides like metformin can cause lactic acidosis under certain conditions but are not linked with ketoacidosis