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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
The use of sodium-glucose co-transporter-2 (SGLT2) inhibitors is growing due to their benefits in chronic kidney disease and heart failure. However, they carry a risk of euglycaemic diabetic ketoacidosis (EDKA), a serious complication. This risk is amplified in the Intensive Care Unit (ICU) setting by prevailing risk factors like fasting and sepsis. Current guidelines recommend temporary cessation of SGLT2 inhibitors in acutely unwell patients, but real-world data on their management and safety monitoring is limited. This bi-national point prevalence study aimed to examine SGLT2 inhibitor prevalence, discontinuation practices, and blood ketone testing in ICU patients.
This was a prospective, multicenter, cross-sectional point prevalence study conducted in ICUs across Australia and New Zealand, gathering data from critically ill adult patients on a single census day. Key data included patient illness severity (APACHE II score), SGLT2 inhibitor use, reasons for discontinuation, and documented unit policies for blood ketone measurement. Marked hyperketonemia was defined as a serum blood ketone level >3.0 mmol/L, meeting the criteria for ketoacidosis in this analysis.
This cohort included 786 patients with the mean age of 60.2±17.2 years. They were male predominant (60.0%) with a median APACHE II score of 17 (IQR: 12–22), highlighting the illness severity of the patient population. A total of, 54 (6.9%) patients were receiving an SGLT2 inhibitor at hospital admission, primarily for type 2 diabetes (75.9%) and heart failure (18.5%) (Figure 1).
SGLT2 inhibitors were discontinued in 28 patients (51.9 during their stay, with the main reasons cited being specific concerns about ketosis or ketoacidosis (six cases) or the general severity of the clinical condition. Regarding institutional practice, only 17 (32.7%) of participating ICUs reported having a documented blood ketone measurement policy, and most did not specifically list SGLT2 inhibitor use as an indication for monitoring. Blood ketone testing was performed in 115 patients (14.6%) across the cohort (Figure 2). Of those tested, 38 (33.0%) showed some degree of hyperketonemia (≥0.6 mmol/L), while six patients (5.2%) met the criteria for marked hyperketonemia (ketoacidosis criteria, >3.0 mmol/L).
This comprehensive point prevalence study found current SGLT2 inhibitor use in 7% of critically ICU inpatients. Clinical practice appeared to vary significantly, characterized by the frequent decision to discontinue the agents—often due to EDKA concerns—and a notable lack of standardized ketone monitoring policies. While ketosis is common in the ICU population, the absolute risk of severe ketoacidosis directly attributable to SGLT2 inhibitors remains unclear. Given the potential benefits of SGLT2 inhibitors, a more systematic and evidence-based approach to medication management and ketone measurement is needed. Further research is needed to clarify the risk-benefit profile of the use of these agents in ICU patients.
