Empagliflozin induced ketoacidosis in a patient presenting with new onset type 2 diabetes mellitus due to indolent pancreas cancer

Sezer, Havva; Yazıcı, Dilek; Deyneli, Oğuzhan; Mericoz, Cisel Aydin; ESİN, Ayla; Alper, Emrah

doi:10.5603/ep.a2020.0012

Cited by 3 publications

(4 citation statements)

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“…There are a few cases in the literature reporting SGLT2i-related DKA in oncology patients that are summarized in Table 2 [13][14][15][16][17]. This was observed with the use of dapagliflozin and empagliflozin as they are the widely used types of SGLT2i with additional approval use for heart failure and chronic kidney disease (CKD).…”

Section: Discussionmentioning

confidence: 99%

“…This was observed with the use of dapagliflozin and empagliflozin as they are the widely used types of SGLT2i with additional approval use for heart failure and chronic kidney disease (CKD). Two patients had adenocarcinoma of the pancreas [15,16], two patients with lung cancer [13,17], and one with colon cancer [14]. The majority of the reported cases developed DKA prior to the initiation of cancer-specific therapy.…”

Section: Discussionmentioning

confidence: 99%

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Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) Associated Diabetic Ketoacidosis in Oncology Patients: A Case Series and Literature Review

AlKindi,

Boobes,

Shalwani

et al. 2024

Cureus

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Sodium-glucose cotransporter 2 inhibitors (SGLT2i) use is associated with an increased risk of diabetic ketoacidosis (DKA). The clinical data regarding the use of SGLT2i and its potential side effects in oncology patients is limited. We are retrospectively reporting four oncology patients with type 2 diabetes mellitus using SGLT2i who were admitted with DKA. The mean age of the patients was 61.25 years, and male to female ratio was 1:1. The duration of type 2 diabetes ranged from 10 to 20 years (mean 15.75 years) and the types of SGLT2i used were empagliflozin 25 mg and dapagliflozin 10 mg. The types of malignancy in our case series included squamous cell carcinoma of the cheek, ovarian cancer, and two patients had laryngeal carcinoma (squamous cell carcinoma). Diabetic ketoacidosis was diagnosed in three patients following chemotherapy or concurrent chemo-radiotherapy. Poor oral intake and infections were the main risk factors in our patients. Mean blood glucose level, anion gap, and bicarbonate level were 11.7 mmol/l, 32.25, and 5 mmol/l, respectively. The majority had moderate DKA based on pH (mean 7.13). The hospital course was complicated by acute kidney injury (n=4), infections (n=4) (urinary tract infections, and pneumonia), and three patients required critical care. The mean length of hospitalization was 19.2 days and no mortality was reported among our patients. SGLT2i-related DKA is an emerging complication recognized in oncology patients. Some of the risk factors for this complication are starvation, poor oral intake, and infection which are quite prevalent in oncology patients. Temporary holding of SGLT2i medication during this period might have a potential preventive role.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) Associated Diabetic Ketoacidosis in Oncology Patients: A Case Series and Literature Review

AlKindi,

Boobes,

Shalwani

et al. 2024

Cureus

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“…e mechanism of action of SGLT2i is independent of insulin and can be used at any stage of illness in T2DM, and in addition to promoting normoglycaemia, they have favourable effects in reducing body weight, blood pressure, Case Reports in Endocrinology reducing atherosclerotic cardiovascular events in patients with established cardiovascular disease, reducing heart failure hospitalisation rates and progression of renal disease [6,7]. Euglycemic acidosis occurring in the context of SGLT2i use in patients with malignancy is scarce, with previous reports documenting its incidence in the case of colorectal cancer [8], pancreatic cancer [9], and lung cancer [10]. Although previous data have demonstrated that SGLT2i-associated euglycemic ketoacidosis is not associated with any particular demographic or comorbid population, perhaps further prospective studies are required to determine whether malignancy can further predispose to the development of euglycemic ketoacidosis and, additionally, whether certain malignancies are associated with an increased risk.…”

Section: Discussionmentioning

confidence: 99%

“…Euglycemic acidosis occurring in the context of SGLT2i use in patients with malignancy is scarce, with previous reports documenting its incidence in the case of colorectal cancer [ 8 ], pancreatic cancer [ 9 ], and lung cancer [ 10 ]. Although previous data have demonstrated that SGLT2i-associated euglycemic ketoacidosis is not associated with any particular demographic or comorbid population, perhaps further prospective studies are required to determine whether malignancy can further predispose to the development of euglycemic ketoacidosis and, additionally, whether certain malignancies are associated with an increased risk.…”

Section: Discussionmentioning

confidence: 99%

Euglycemic Ketoacidosis in a Patient with Metastatic Non-Small-Cell Lung Adenocarcinoma and Concomitant Pulmonary Embolism

O’Neill

Tyack

Freeman

et al. 2020

Case Reports in Endocrinology

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Euglycemic ketoacidosis is a recognised side effect secondary to sodium-glucose cotransporter 2 inhibitor use in the treatment of type 2 diabetes mellitus; however, there is scarce evidence to suggest whether preexisting comorbid conditions contribute to the development of this potentially life-threatening complication. We describe a case of euglycemic ketoacidosis in a patient with type 2 diabetes mellitus in the context of empagliflozin use after a recent diagnosis of metastatic lung adenocarcinoma. The diagnosis was complicated by a pulmonary embolism and hospital-acquired pneumonia, and was subsequently established after an anion-gap metabolic acidosis was identified on arterial blood gas and serum ketone measurement. The patient required admission to the intensive care unit for fluid resuscitation and regular intravenous insulin to ensure resolution of acidosis and maintenance of normoglycaemia. The patient was discharged to home for outpatient single-agent pembrolizumab for treatment of his lung adenocarcinoma. This article highlights the importance or awareness of oral hypoglycaemic medications and their side effects, along with providing further evidence for the potential contribution of malignancy to the development of euglycemic ketoacidosis in a patient with type 2 diabetes mellitus.

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Empagliflozin

2020

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Empagliflozin induced ketoacidosis in a patient presenting with new onset type 2 diabetes mellitus due to indolent pancreas cancer

Cited by 3 publications

References 0 publications

Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) Associated Diabetic Ketoacidosis in Oncology Patients: A Case Series and Literature Review

Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) Associated Diabetic Ketoacidosis in Oncology Patients: A Case Series and Literature Review

Euglycemic Ketoacidosis in a Patient with Metastatic Non-Small-Cell Lung Adenocarcinoma and Concomitant Pulmonary Embolism

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