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We present a case of a 32‐year‐old diabetic woman with Prader–Willi syndrome who developed severe ketoacidosis caused by a sodium‐glucose cotransporter 2 ( SGLT 2) inhibitor, a novel class of antihyperglycemic agents, during a strict low‐carbohydrate diet. At admission, a serum glucose level of 191 mg/ dL  was relatively low, though laboratory evaluations showed severe ketoacidosis. This is the first report of ketoacidosis caused by a  SGLT 2 inhibitor. It is necessary to not only pay attention when using a  SGLT 2 inhibitor in patients following a low‐carbohydrate diet, but also to start a low‐carbohydrate diet in patients treated with a  SGLT 2 inhibitor because of a high risk for developing ketoacidosis.

Case of ketoacidosis by a sodium‐glucose cotransporter 2 inhibitor in a diabetic patient with a low‐carbohydrate diet