Euglycemic DKA — nausea, vomiting, abdominal pain, and rapid breathing even with normal glucose; report immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is prescribed an SGLT2 inhibitor (for example, empagliflozin) for type 2 diabetes. Which teaching point is most important?
Answer: A. SGLT2 inhibitors lower glucose by promoting urinary glucose excretion, which increases the risk of genital and urinary tract infections; clients should maintain good hydration and perineal hygiene and report infection symptoms. These agents can also rarely cause euglycemic DKA. Glucosuria is expected with this class, and the drug is taken orally, not injected.
Question 2 of 5
A client with diabetes is prescribed an SGLT2 inhibitor such as empagliflozin. Which instruction should the nurse provide?
Answer: B. SGLT2 inhibitors lower glucose by increasing urinary glucose excretion, which raises the risk of genital and urinary tract infections and can cause volume depletion. The nurse should teach the client to maintain hydration and report symptoms of infection. These drugs do not require taking extra insulin with each dose and do not cause the urine to be ketone-free.
Question 3 of 5
A client is prescribed an SGLT2 inhibitor (for example empagliflozin). The nurse teaches the client about which common side effect linked to its mechanism?
Answer: A. SGLT2 inhibitors lower glucose by blocking renal reabsorption of glucose, causing glucose to be excreted in the urine (glycosuria). This sugar-rich urine increases the risk of genital and urinary tract infections, so the client should maintain good hygiene and report symptoms. They also cause increased urination.
Question 4 of 5
A client with heart failure is started on lisinopril, an ACE inhibitor. Which adverse effect should the nurse teach the client to report?
Answer: B. A persistent dry, nonproductive cough is a classic adverse effect of ACE inhibitors due to bradykinin accumulation and may warrant switching to an ARB. Angioedema and hyperkalemia are also concerns. Increased appetite is not associated; ACE inhibitors lower (not raise) blood pressure, so hypertension is not the expected effect.
Question 5 of 5
A client newly prescribed an ACE inhibitor (lisinopril) for heart failure should be taught to report which symptom that may indicate a serious adverse effect?
Answer: B. Swelling of the face, lips, or tongue (angioedema) is a serious, potentially life-threatening reaction to ACE inhibitors that must be reported immediately. A persistent dry, nonproductive cough from bradykinin accumulation is also common but less emergent. Increased appetite, occasional hiccups, and a metallic taste are not characteristic warning signs of ACE inhibitors.
Keep the streak going with more questions like these, each with a full rationale.
What is sglt2 inhibitors?
Beyond glucose control, they provide cardiovascular and renal protection and are used in heart failure and chronic kidney disease. The 'flozin' suffix flushes sugar out through the urine.
Key points to remember
- Mechanism: block sodium-glucose cotransporter 2 in the proximal renal tubule, increasing urinary glucose excretion.
- Cause osmotic diuresis leading to increased urination, dehydration risk, and modest weight loss and blood pressure reduction.
- Increased urinary glucose raises the risk of genital yeast infections and urinary tract infections.
- Provide proven cardiovascular and kidney protection; used in heart failure and CKD even in some non-diabetics.
- Can cause euglycemic diabetic ketoacidosis (DKA with near-normal glucose) and serious genital infection (Fournier gangrene).
Signs & symptoms
- Polyuria → dehydration
- Orthostatic hypotension
Nursing priorities
- Monitor hydration status, blood pressure, and renal function due to diuretic effect.
- Assess for and teach prevention of genital and urinary tract infections with good perineal hygiene.
- Hold the drug before major surgery or during acute illness to reduce euglycemic DKA risk.
- Encourage adequate fluid intake and monitor for orthostatic hypotension.
Labs & values
Patient teaching
- Drink plenty of fluids to prevent dehydration and dizziness when standing.
- Practice good perineal hygiene and report itching, discharge, or burning with urination.
- Recognize DKA symptoms (nausea, vomiting, belly pain, fruity breath, fast breathing) and seek care even if glucose seems normal.
- Report any genital pain, swelling, or redness with fever immediately.
- Hold the medication and call the provider if you cannot eat or drink due to illness or before surgery.
Red flags: report now
- Euglycemic DKA — nausea, vomiting, abdominal pain, and rapid breathing even with normal glucose; report immediately.
- Severe perineal pain, swelling, redness, or fever — possible Fournier gangrene; report now.
- Never continue during prolonged fasting, dehydration, or acute serious illness without provider guidance.
References
Clinical references for this topic
