The use of sodium-glucose cotransporter-2 (SGLT2) inhibitors has recently been associated with euglycemic diabetic ketoacidosis (euDKA) . The absence of hyperglycemia can delay recognition of euDKA. We aimed to increase screening rates for euDKA by implementing a passive alert to providers in the EHR (built as a BestPractice Advisory [BPA] on the Epic Storyboard) if an emergency department or hospitalized patient taking an SGLT2 inhibitor was at risk for euDKA. Criteria were blood glucose <250 mg/dL, SGLT2 inhibitor on the home medication list or initiated in the hospital, lack of an insulin infusion, and one of the following labs indicating acidosis: 1) anion gap >12 with serum bicarbonate <18 mmol/L, 2) urine ketones ≥ 3+, or 3) serum ketones ≥ 2 mmol/L. We conducted a retrospective review of the alert from implementation on 5/15/2021 until 12/13/2021. Of the 76 patients who triggered the alert, 13 (18%) had euDKA confirmed and 5 (7%) may have had it but were not evaluated for it. The alert introduced in the electronic health record successfully identified patients taking an SGLT2 inhibitor who were at risk for euDKA and may serve as a safety net to reduce delayed recognition of this serious condition.


D. Soliman: None. R. Musser: None. J. P. Jackson: None. J. German: None. S. Carlson: None. K. H. Odonnell: None. T. Setji: None.

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