High Anion Gap Metabolic Acidosis due to Euglycemic Diabetic Ketoacidosis Caused by Sodium-Glucose Co-transporter 2 inhibitor

The case is that of 58 year-male with type 2 diabetes mellitus for 7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high anion-gap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine.