A 45-year-old male patient with type 2 diabetes developed euglycemic diabetic ketoacidosis (euDKA) after combined use of ertugliflozin and metformin. Four days after medication, the patient developed chest tightness, shortness of breath, fever, accompanied by urinary frequency and dysuria. Laboratory findings showed random blood glucose of 6.5 mmol·L^-1, ketone bodies of 3.1 mmol·L^-1, and metabolic acidosis on arterial blood gas analysis (pH 7.27, actual bicarbonate 6.9 mmol·L^-1). EuDKA was diagnosed, with suspected urinary tract infection. Ertugliflozin was promptly discontinued. Treatments such as fluid resuscitation, low-dose insulin infusion via pump, electrolyte correction, and anti-infective therapy were administred. Symptoms gradually improved, and ketone bodies turned negative after three days. Using the Naranjo’s Assessment Scale, the association between euDKA and the suspected drug ertugliflozin was rated as “probable” (score 7). This case suggested that concomitant use of SGLT2 inhibitors and metformin, especially with co-existing infection, may significantly increase the risk of euDKA. Enhanced medication evaluation and monitoring were recommended in clinical practice.

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