Empagliflozin-Induced Nondiabetic Ketoacidosis in Advanced Alcoholic Liver Disease.

A 67-year-old man with advanced alcoholic-associated liver disease developed nondiabetic ketoacidosis shortly after starting empagliflozin for congestive heart failure. He presented with high anion-gap metabolic acidosis, elevated beta-hydroxybutyrate levels, and hypoglycemia. The condition resolved promptly after empagliflozin discontinuation and initiation of intravenous fluids, thiamine, and dextrose therapy.

Sodium-Glucose Cotransporter-2 Inhibitors in Liver Cirrhosis: A Systematic Review of Their Role in Ascites Management, Slowing Disease Progression, and Safety.

Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are widely used for type 2 diabetes mellitus (T2DM), conferring cardiovascular and renal benefits with evidence supporting their role in metabolic-associated steatotic liver disease (MASLD), the fastest rising etiology for liver cirrhosis. Our study collects and synthesizes all available data on SGLT2I use in liver cirrhosis to summarize their potential benefits and risks. We systematically reviewed the literature on SGLT2I use in adults with cirrhosis, focusing on 6 outcome domains, including ascites reduction, disease progression, hemodynamics, acute kidney injury (AKI), electrolyte abnormalities, and infection risk.