OBJECTIVE: Canagliflozin is a sodium-glucose co-transporter 2 (SGLT-2) 
inhibitor, one of a class of novel antiglycemic agents that are gaining in 
popularity in the treatment of diabetes.
METHODS: We describe a case in which a patient experienced difficult-to-treat 
metabolic ketoacidosis in the setting of canagliflozin use.
RESULTS: A 52-year-old man with type 2 diabetes mellitus developed profound 
ketoacidosis without overt hyperglycemia while taking canagliflozin. Despite 
initiation of an insulin infusion, the metabolic acidosis persisted for 3 days.
CONCLUSION: Treatment with canagliflozin was associated with development of 
euglycemic ketoacidosis.