Euglycemic ketoacidosis is defined by the triad of euglycemia, metabolic acidosis and ketonemia or ketonuria. In the current era of diabetic management, it is a serious concern with the usage of sodium glucose co-transporter 2 (SGLT2) inhibitors potentiated by a number of precipitating agents. Empagliflozin though a novel oral hypoglycemic agent in this category may also lead to this potential complication. Here we report a 59 year old male, type 2 diabetic who was on empagliflozin and presented with euglycemic ketoacidosis after a binge of alcohol.
Tenofovir disoproxil fumarate (TDF) is the foundation nucleotide reverse-transcriptase inhibitor in the recommended first-line regimen for all naive human immunodeficiency virus-1 (HIV-1) patients whose age is more than 10 years and body weight is more than 30 kg. Although it has a good safety profile overall, nephrotoxicity is a concern and its overall incidence is 1-6% with a long period of clinical latency. Nephrotoxicity may manifest as either proximal renal tubule dysfunction in the form of a partial or complete Fanconi syndrome or as decreased renal function leading to acute or chronic kidney injury. Osteomalacia can also develop secondary to complicating hypophosphataemia and low calcitriol levels. Here we report a 50-year-old HIV-positive male on tenofovir who presented with proximal renal tubular acidosis and fracture of left neck of femur four years after initiation of the drug.
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