Abstract: Objective To investigate the characteristics of dapagliflozin-induced euglycemic diabetic ketoacidosis so as to provide reference for clinical safe and rational use of dapagliflozin. Methods Literature about euglycemic diabetic ketoacidosis induced by dapagliflozin published as of June 2019 was retrieved from CNKI, VIP Chinese full-text database, Wanfang database, Pubmed and Embase. The basic information, drug use, treatment, risk factors, outcomes and relevance evaluation of the cases were statistically analyzed. Results A total of 29 papers involving 41 cases were included. There were 13 males and 28 females with an average age of (52.15±15.32) years old. 50.00% of the adverse reactions occurred within one month after medication. The most common clinical symptoms were vomiting, nausea, abdominal pain, dyspnea and weakness. At the time of diagnosis, blood glucose averaged 10.13 mmol/L, pH 7.15, blood bicarbonate 8.65 mmol/L, anion gap 25.05 mmol/L, and β-hydroxybutyrate 5.85 mmol/L. The most common risk factors included surgery, low-carbohydrate diets, infections, and insulin reduction or discontinuation. Forty patients recovered after treatment, but one patient died. The results of relevance evaluation were all "very likely". Conclusion We should be alert to the risk of euglycemic diabetic ketoacidosis induced by dapagliflozin, and strengthen the follow-up for high-risk patients in the initial stage of dapagliflozin medication so as to treat patients with symptoms of ketoacidosis as early as possible and ensure the safety of drug use.

Key words: dapagliflozin, euglycemic diabetic ketoacidosis, literature review