# Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. Highlight the current symptoms and laboratory findings that establish euglycemic diabetic ketoacidosis despite glucose below 250 mg/dL. Do not select medication exposure or unrelated normal findings. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522749&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. Highlight the current symptoms and laboratory findings that establish euglycemic diabetic ketoacidosis despite glucose below 250 mg/dL. Do not select medication exposure or unrelated normal findings. Emergency Record\nThe client takes empagliflozin for type 2 diabetes. During two days of fever and minimal intake, the client developed repeated vomiting and deep rapid respirations. Results are glucose 184 mg/dL, bicarbonate 12 mEq/L, venous pH 7.24, and beta-hydroxybutyrate 5.2 mmol/L. The creatinine is 0.9 mg/dL, the lactate is 1.4 mmol/L, the oxygen saturation is 98% on room air, the abdomen is soft without guarding, the no recent alcohol intake is reported, and the last A1C was 7.2 percent. ## Explanation Empagliflozin use, acute infection, minimal intake, vomiting, deep rapid respirations, bicarbonate 12 mEq/L, pH 7.24, and beta-hydroxybutyrate 5.2 mmol/L support euglycemic DKA despite a glucose of 184 mg/dL. ## In-depth explanation Quick answer Do not let near-normal glucose hide ketonemia and metabolic acidosis. Why this is correct SGLT2 inhibitors increase urinary glucose loss, so serious ketoacidosis may present without marked hyperglycemia. Infection, reduced caloric intake, vomiting, and dehydration add insulin deficiency and counterregulatory stress. Easy analogy or mental picture Build a medication safety chain: identify the cue cluster, connect it to the drug mechanism, stop preventable exposure, stabilize the client, and verify the response with measurable findings. Memory hook Cue cluster, medication mechanism, protective action, and measurable reassessment. NCLEX decision rule Choose the action that prevents the most immediate medication-related harm while preserving treatment for the underlying condition. Why the other choices are wrong Options that rely on one reassuring value, continue a suspect exposure, bypass monitoring, or delay escalation leave the medication hazard active.References 1FDA Drug Safety Communication: SGLT2 inhibitor ketoacidosisKetoacidosis can occur with lower-than-expected glucose during infection, reduced intake, surgery, dehydration, or insulin reduction 22024 Consensus Report: Hyperglycemic Crises in Adults With DiabetesEuglycemic DKA recognition, fluids, insulin, dextrose, potassium, precipitant treatment, and resolution criteria 3Surviving Sepsis Campaign International Guidelines 2021Prompt infection evaluation, cultures when appropriate, antimicrobials, fluids, perfusion, and serial reassessment ## Clinical scenario Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. 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