Cardiac arrest from acute myocardial infarction complicated with sodium-glucose cotransporter 2 inhibitor-associated ketoacidosis

Dai, Zhehao; Nishihata, Yosuke; Kawamatsu, Naoto; Komatsu, Ikki; Mizuno, Atsushi; Shimizu, Masato; Toya, Nozomi; Ishimatsu, Shinichi; Komiyama, Nobuyuki

doi:10.1016/j.jccase.2016.10.006

Cited by 10 publications

(5 citation statements)

References 11 publications

(14 reference statements)

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“…Most patients developing euglycemic DKA may have a precipitating event. The commonly reported factors include surgery, infections including COVID-19, pericarditis, concurrent ketogenic/low carbohydrate diets, a recent change of diabetic regimen with reduction or omission of insulin dosages, nausea and vomiting, gastroparesis, pregnancy, and acute pancreatitis [12][13][14][15][16][17][18][19]. Diagnosis is often delayed or missed in these settings, like in our case presentation.…”

Section: Discussionmentioning

confidence: 90%

“…Typically, from most of the reported cases, eu-DKA has been managed similar to hyperglycemic DKA with intravenous insulin, fluids, and frequent monitoring of serum electrolytes until anion gap acidosis resolution [12][13][14][15][16][17][18][19]. But, patients could be conservatively managed like in our case.…”

Section: Discussionmentioning

confidence: 91%

“…Diagnosis is often delayed or missed in these settings, like in our case presentation. The reported blood glucose in these cases ranged from 127-212 mg/dL [12][13][14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Euglycemic Ketoacidosis in Type 2 Diabetes Associated with Sodium-Glucose Cotransporter 2 Inhibitor: Insights Into Pathogenesis and Management Strategy

Chandrakumar¹,

Chillumuntala²,

Singh³

et al. 2021

Cureus

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Euglycemic diabetic ketoacidosis (eu-DKA) is an uncommon and serious adverse event associated with the use of sodium-glucose cotransporter (SGLT-2) inhibitors. It is a state of increased anion gap metabolic acidosis with ketosis but in the setting of normal serum glucose levels. Diagnosis of this serious entity could easily be missed given the non-specific symptoms and the normal glucose measurements. This ketogenic state can be triggered by various stressors including infection, surgery, myocardial infarctions, omission of insulin dosage, as well as low carbohydrate diet. In this report, we present a case of eu-DKA in a 68-year-old woman with type 2 diabetes that occurred in the postoperative period of glaucoma surgery. She was started shortly before surgery on SGLT-2 inhibitor (ertugliflozin). While the diagnosis was initially missed, it was subsequently confirmed when she presented with reduced appetite, generalized fatigue, and constipation. Ertugliflozin was discontinued, and she was successfully treated with conservative management and without insulin drip. This case highlights the need to consider the diagnosis of eu-DKA in patients treated with SGLT-2 inhibitors since the diagnosis could easily be missed especially in the postoperative period with the non-characteristic symptomatology and normoglycemia.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 91%

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Postoperative Euglycemic Ketoacidosis in Type 2 Diabetes Associated with Sodium-Glucose Cotransporter 2 Inhibitor: Insights Into Pathogenesis and Management Strategy

Chandrakumar¹,

Chillumuntala²,

Singh³

et al. 2021

Cureus

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“…In addition to dehydration, some mechanisms might explain the occurrence of DMI in acute complications. Several studies have focused on myocardial infarction in patients with decompensated diabetes, such as those with DKA ( 6 ). As a result of hyperviscosity and increased coagulation, DKA precipitates a prothrombotic environment ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Diabetic muscle infarction with diabetic ketoacidosis: A rare complication of diabetes

Tang

Li²,

Hu³

et al. 2023

Front. Endocrinol.

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BackgroundDiabetic muscle infarction (DMI), which is also referred to as diabetic myonecrosis, is a rare and long-term complication of poorly controlled diabetes mellitus, while we found that acute diabetes decompensation, such as diabetic ketoacidosis (DKA), could also stimulate the occurrence and development of DMI.Case presentationA 23-year-old woman with type 1 diabetes presented with a 10-day history of nausea, vomiting, pain, and swelling of her left leg. Her urine ketone test was positive. The 3-beta-hydroxybutyrate and leukocyte counts and creatine kinase levels were elevated. Magnetic resonance imaging of the left thigh revealed extensive deep tissue oedema and an increase in the T2 signal in the involved muscles. Once the diagnosis of DMI was made, she was managed with rest, celecoxib, clopidogrel and aggressive insulin therapy. Three months after treatment, the patient reported complete resolution of symptoms.ConclusionDMI is a rare DM complication with a high recurrence rate, commonly presenting with chronic complications, while our case report shows that acute diabetes decompensation, such as DKA, can stimulate the occurrence and development of DMI. Timely diagnosis and appropriate treatment could shorten the recovery time.

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“…Treatment with fluids should be continued once anion gap closure is achieved. Once euDKA is diagnosed, SGLT2i should be discontinued permanently at the time of recovery from acute phase of illness, to prevent further complications, such as respiratory failure, cerebral edema, myocardial infarction, seizures, coma, and ultimately death [5,13].…”

Section: Discussionmentioning

confidence: 99%

A Case of SGLT-2i Induced Euglycemic Diabetic Ketoacidosis in the Setting of Gastrointestinal Stress

Reddy¹,

Tailor²,

Tănase³

2022

Int J Diabetes Case Rep

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Euglycemic DKA (euDKA) is a rare, uncommon variant of DKA, characterized by the imbalance between insulin and counterregulatory hormones. Lately, the use of SGLT2 inhibitors is known to incite euDKA, which is often missed on initial presentation. In this case, we present a scenario of a 61-year-old African American male with a history of hypertension, CAD s/p CABG, and type 2 diabetes mellitus on SGLT2i (empagliflozin) with a clinical picture of normoglycemic DKA process. With a pH of 7.14, bicarbonate of 8 mEq/L, anion gap (AG) of 17mEq/L, ketoacidosis, and glucosuria, the patient met criteria for euDKA; however, the initial clinical diagnosis of euDKA was overlooked by the possibility of an underlying infectious gastroenteritis, given his recent history of travel with passengers with similar presentation, causing a delay in euDKA management. The management of euDKA is like that of a typical DKA, inculcating aggressive fluid resuscitation and insulin, followed by a permanent discontinuation of SGLT2i. Thus, this case highlights the importance of understanding SGLT2i induced euDKA and its early diagnostic and timely management to prevent further complications.

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Cardiac arrest from acute myocardial infarction complicated with sodium-glucose cotransporter 2 inhibitor-associated ketoacidosis

Cited by 10 publications

References 11 publications

Postoperative Euglycemic Ketoacidosis in Type 2 Diabetes Associated with Sodium-Glucose Cotransporter 2 Inhibitor: Insights Into Pathogenesis and Management Strategy

Postoperative Euglycemic Ketoacidosis in Type 2 Diabetes Associated with Sodium-Glucose Cotransporter 2 Inhibitor: Insights Into Pathogenesis and Management Strategy

Case report: Diabetic muscle infarction with diabetic ketoacidosis: A rare complication of diabetes

A Case of SGLT-2i Induced Euglycemic Diabetic Ketoacidosis in the Setting of Gastrointestinal Stress

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