Euglycemic diabetic ketoacidosis in association with dapagliflozin use after gastric sleeve surgery in a patient with type II diabetes mellitus

Abstract

Key Clinical Message Sodium–glucose cotransporter 2 inhibitors (SGLT2Is) can be associated with euglycemic diabetic ketoacidosis (eDKA). Severe metabolic acidosis with extreme electrolyte abnormalities can occur with nonsignificant blood glucose elevations in SGLT2I‐treated patients. Additional risk factors for eDKA include prolonged fasting, major illness, large weight loss, and reductions in insulin doses.

Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers

“…We reviewed the included articles for the risk factors and precipitants for EDKA in patients taking SGLT2i. We noticed 11 cases associated with pre/postoperative fasting, three associated with pancreatic etiology, five associated with low carbohydrate or keto diet, one with malignancy, and one in an obese adolescent [ 20 - 33 ].…”

Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting – A Possibly Dangerous Diet Trend

“…This risk is particularly high for patients who participate in prolonged fasting, had large weight loss, or have major illness. Furthermore, euglycemic diabetic ketoacidosis typically presents with severe metabolic acidosis, while starvation ketoacidosis typically presents with a pH above 7.3 and serum bicarbonate more than 18 mEq/L [15]. Clinicians must remember to keep a broad differential when evaluating patients with acute metabolic acidosis.…”

Euglycemic diabetic ketoacidosis induced by empagliflozin, sodium-glucose cotransporter-2 inhibitor, in patient with diabetes mellitus type 2 after thoracic surgery

“…Studija je pokazala da primjena SGLT2i-ja smanjuje postotak HbA 1c , potrebu za inzulinom i tjelesnu težinu, skraćuje hospitalizacije zbog srčanog zatajivanja te snižava stopu smrtnosti od svih uzroka. [1][2][3] SGLT2i djeluje na kotransporter epitelnih stanica proksimalnih kanalića bubrega i sprječava reapsorpciju Na i glukoze. Pritom dolazi do glukozurije, sniženja vrijednosti GUK-a i smanjenog izlučivanja inzulina.…”

“…Sniženje razine natrija dovodi do gubitka tekućine i pada tlaka. [1][2][3] SGLT2i može uzrokovati eDKA u bolesnika s tipom 1 šećerne bolesti i u onih sa šećer-nom bolesti tipa 2, 2,4 pri prolongiranom gladovanju, 3 kod velikih kirurških operacija 3 , u alkoholičara, 5 pri dehidraciji 3,5 i kod dijete s malenim udjelom ugljikohidrata. 5 U ovom radu prikazujemo bolesnicu koja je nakon resekcijskog zahvata na plućima dobila eDKA.…”

“…Vrijednosti GUK-a u hiperglikemijskoj ketoacidozi više su od 26,3 ± 14,8 mmol/L, 3,6,7 dok je pri euglikemijskoj ketoacidozi GUK < 14,0 mmol/L. 3,6,7 U tipičnoj ketoacidozi pH je 7,2 ± 0,02, bikarbonati su 12,1 ± 6,6 mmol/L, BE negativni 16 ± 8 mmol/L. 7 Dijabetička ketoacidoza može biti blaga, srednja i teška (tablica 2.…”