Diabetic ketoacidosis without hyperglycemia as a complication of SGLT2 inhibitors treatment

Trojanowska-Grigoriew, Monika; Majkowska, Lilianna

doi:10.5603/dk.2016.0011

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Recognized predisposing factors for euglycemic DKA are dehydration, major trauma, prolonged fasting, sepsis, and surgery. 29,30 Clinical Presentation and Management HHS presentation is often insidious over days or weeks. Altered level of consciousness may be present and is more frequent than in DKA.…”

Section: Epidemiologymentioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

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This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.

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Section: Epidemiologymentioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

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“…The most common adverse effects of dapagliflozin are: urinary tract infections, euglycemic ketoacidosis and, when used simultaneously with insulin, hypoglycaemia [6,9].…”

Section: Introductionmentioning

confidence: 99%

Zastosowanie dapagliflozyny w terapii cukrzycy typu 1 u 36-letniej kobiety - opis przypadku

Rutkowska

Cypryk

2021

Clinical Diabetology

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Until recently, insulin was the only medicine used in therapy of type 1 diabetes mellitus (T1DM). As our knowledge of pathomechanisms involved in diabetes evolves, other promising drugs are being introduced, e.g. metformin in the patients with insulin resistance or sodium-glucose cotransporter 2 (SglT-2) inhibitors in patients with poor metabolic control. The first SGLT-2 inhibitor (dapagliflozin) has been recently approved by the National Institute for Health and Clinical Excellence (niCE) for additional treating of poorly controlled type 1 diabetes. This article presents a case of patient with type 1 diabetes successfully treated with insulin and dapagliflozin at a daily dose of 5 mg.

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“…6,7 However, one serious potential complication is diabetic ketoacidosis, specifically euglycemic diabetic ketoacidosis (diabetic ketoacidosis with a normal or relatively normal blood glucose level). 8,9 This rare but serious complication has been noted by the FDA, and it is now listed as a black box warning for this class of drug. In their correspondence regarding this issue, the FDA noted that they had received numerous reports of delays in diagnosis and treatment of diabetic ketoacidosis due to its presentation with blood glucose levels much lower than what would be expected in a patient with diabetic ketoacidosis.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Euglycemic Diabetic Ketoacidosis and Encephalopathy Related to SGLT-2 Inhibitors: A Case Report and Discussion of Diabetes Treatment and “Sweet Pee Encephalopathy” in Perioperative Hospital Management

Mackintosh

Tewari

Siegel

et al. 2019

The Neurohospitalist

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During preanesthesia evaluation, patient medications are reviewed and many are not administered on the day of surgery. Additionally, neurosurgical patients can develop postoperative encephalopathy from a variety of etiologies, including metabolic derangements. We report a case of postoperative neurosurgical euglycemic ketoacidosis which presented as unexplained encephalopathy and was the result of continued action of the patient’s serum glucose cotransporter-2 (SGLT-2) inhibitor combined with perioperative fasting. A 68-year-old woman with a history of type 2 diabetes mellitus was admitted to the neurocritical care service after resection of a left temporal meningioma. On postop day 1, she became lethargic and with worsening aphasia. Laboratory studies revealed blood glucose 140 to 160 mmol/L, bicarbonate 9 mmol/L, anion gap of 21, and pH of 7.2. Urine was positive for ketones and glucose, and serum was positive for β-hydroxybutyrate. Endocrinology was consulted and the patient was diagnosed with euglycemic diabetic ketoacidosis and treated with insulin until her anion gap closed. Over the next 2 days, her neurological examination improved to baseline. Although the patient did not take empagliflozin the day of surgery, the drug has a half-life of >12 hours, and other reports have described continued glycosuria for up to 10 days after drug discontinuation. This case illustrates the need for increased awareness of SGLT-2 inhibitors and “sweet pee encephalopathy” among neurosurgical and neurointensivist teams as well as potential modification of perioperative management of patients using newly emerging SGLT-2 inhibiting pharmaceuticals.

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Diabetic ketoacidosis without hyperglycemia as a complication of SGLT2 inhibitors treatment

Cited by 3 publications

References 22 publications

Metabolic and Endocrine Challenges

Metabolic and Endocrine Challenges

Zastosowanie dapagliflozyny w terapii cukrzycy typu 1 u 36-letniej kobiety - opis przypadku

Postoperative Euglycemic Diabetic Ketoacidosis and Encephalopathy Related to SGLT-2 Inhibitors: A Case Report and Discussion of Diabetes Treatment and “Sweet Pee Encephalopathy” in Perioperative Hospital Management

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