Dapagliflozin (SGLT2-i) induced euglycaemic diabetic ketoacidosis

Abstract

Sodium glucose co-transporter-2 inhibitors (SGLT2-i) have become a popular therapeutic strategy in the management of hyperglycaemia in type 2 diabetes mellitus. The primary site of action of SGLT2-i is at the proximal renal convoluted tubule. They work by blocking SGLT2 receptors, sodium-dependent glucose co-transport molecules, which in turn prevents glucose reabsorption, facilitating glucosuria, improving glycaemic control as well as a moderate degree of weight loss. We report the case of a 51-year-old woman admitted to the acute medical unit with abdominal pain and vomiting, who was diagnosed with euglycaemic diabetic ketoacidosis secondary to recent initiation of an SGLT2-i medication (dapagliflozin). Clinicians should be aware of this rare side effect of SGLT2-i, to circumvent delays in patient management.

Dapagliflozin-Associated Euglycemic Diabetic Ketoacidosis Presenting With Severe Abdominal Pain Mimicking Acute Peritonitis

“…In previous reported cases, the main symptoms of eu-DKA are disturbance of consciousness, dyspnea, nausea, or vomiting [2][3][4][5][6]. However, no reports have described eu-DKA with severe abdominal pain (mimicking acute peritonitis) as the predominant symptom due to SGLT-2 inhibitors.…”

“…Sodium glucose co-transporter-2 (SGLT2) inhibitors have become a popular therapeutic strategy in the management of hyperglycaemia in type 2 diabetes mellitus (DM) by inhibiting renal SGLT-2 receptors responsible for glucose reabsorption [1]. However, there has been a gradual increase in reports on diabetic keto acidosis (DKA) after administration of SGLT-2 inhibitors [2][3][4][5][6]. We herein report a rare case of euglycemic diabetic keto acidosis (eu-DKA) with severe abdominal pain as the main symptom, which was misdiagnosed as gastrointestinal perforation followed by unnecessary laparotomy.…”

Life-threatening complications for diabetic patients taking SGLT2 inhibitors when undergoing surgery: A poorly recognised problem?

“…Unfortunately, they have also been associated with significant side effects, the most severe of these appears to be euglycaemic ketoacidosis (Ahn et al 2019, Chacko et al 2018, Finucane 2018, Hoffman et al 2017, Jhaveri & Vardesh 2019, Latif et al 2020, Leader et al 2019, Rafey et al 2019, Rashid et al 2016, Sampani et al 2020, Sanusi et al 2020, van Niekerk et al 2018) diabetic ketoacidosis in the context of normal blood sugars (plasma glucose level < 14 mmol/L) (Goldenberg et al 2016).…”