Purpose/Background: Euglycemic diabetic ketoacidosis (EDKA) falls under the umbrella of diabetic ketoacidosis (DKA) and can occur in patients with type 1 or type 2 diabetes mellitus. EDKA is thought to be caused by a renal threshold for glucosuria that is lower due to increased gluconeogenesis and free fatty acid metabolism. A common medication class prescribed to patients with diabetes mellitus, sodium-glucose cotransporter-2 (SGLT2) inhibitors, are thought to inhibit both glucose and sodium resorption at the renal proximal tubule which leads ultimately to glucosuria and negative fluid balances. These mechanisms lead to a loss of bicarbonate and cause ketogenesis, which ultimately leads to EDKA. The purpose of this study is to evaluate the effect of pharmacy monitoring on the appropriate clinical courses in patients on sodium-glucose cotransporter-2 inhibitors who are admitted for euglycemic diabetic ketoacidosis in a regional medical center. Methodology: Data will be collected based on a pre- and post-evaluation of the electronic medical record. Prospective data collection will be done through a daily report of patients that are greater than or equal to 18 years old, admitted to CaroMont Regional Medical center, have an SGLT2 inhibitor on their prior to admission medication list, and have a diagnosis of diabetes on their hospital problem list. Patients will be excluded if they are less than 18 years old, have no diagnosis of diabetes mellitus, have a glucose on admission that is > 250 mg/dL, are pregnant or incarcerated. Once the daily report is run, the clinical pharmacist will ensure the correct lab values and medications are ordered. If a patient meets EDKA criteria, a clinical pharmacist will evaluate the need for additional evaluation, including β-hydroxybutyrate, to strengthen diagnostic criteria and guide potential treatment. Retrospective data collection will be done through the collection of pre-specified criteria and analysis of the treatment course in patients that presented with EDKA. Both data sets will be taken from the same months, one year apart. The data sets will be compared to assess the effectiveness of pharmacy interventions. The primary endpoint of the study will be the time to resolution of euglycemic diabetic ketoacidosis. Time to insulin infusion, length of stay, number of admissions, and number of clinical pharmacist interventions will also be assessed. Results: Pending Conclusions: Pending Presentation Objective: To describe the benefit of pharmacy interventions in the treatment course of patients that present with euglycemic diabetic ketoacidosis secondary to receiving sodium-glucose cotransporter-2 inhibitors for management of their diabetes prior to admission. Self-Assessment: What are the criteria for a diagnosis of euglycemic diabetic ketoacidosis? Authors: Rylee Williams, Joe Norton, Joanna Nixon
