Perioperative euglycemic diabetic ketoacidosis following use of SGLT-2 inhibitors after cardiac surgery

Pontes, João Paulo Jordão; Melo, Caroline Souto de; Arantes, Flávia Bittar Britto; Ramos, Juan Thomaz Gabriel de Souza; Módolo, Norma Sueli Pinheiro; Lima, Laís Helena Navarro e

doi:10.1016/j.jclinane.2021.110201

Cited by 8 publications

(8 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The onset of EDKA was recognized between POD 0 [withhold of SGLT2-I for 48 h prior to surgery ( 38 )] and 6 weeks after [under SGLT2-I intake ( 1 )] surgery, hence, reflecting a wide range of clinical presentation. Reported patients were between 42 ( 31 ) and 76 ( 2 ) years of age, were prescribed empagliflozin ( 2 , 33 , 37 – 45 , 47 – 50 , 55 ), ertugliflozin ( 53 ), canagliflozin ( 2 , 31 – 33 , 35 , 36 , 49 , 54 ), or dapagliflozin ( 1 , 27 , 35 , 41 , 46 , 51 , 54 ), and female gender was an assumed risk factor ( 56 ). A long history of diabetes duration (>10 years) and the use of oral antidiabetics with or without insulin application were reported as predisposing patients' characteristics ( 57 ).…”

Section: Resultsmentioning

confidence: 99%

“…As iatrogenic-induced glucosuria is the consequence of SGLT2-inhibition, blood glucose levels may remain near to normoglycemic in EDKA ( 26 , 59 ). With a so-called second hit trigger that promotes a ketogenic metabolic state, ketoacidosis can be achieved in times of relative/absolute insulin deficiency ( 25 , 41 ). Thus, some precipitating factors have been identified in the literature ( 60 ).…”

Section: Resultsmentioning

confidence: 99%

“…In this case, perioperative fasting and surgical disease were predisposing factors. In the perioperative period decreased oral intake and/or fasting and surgical stress contributed to a ketogenic state and glucagon secretion with consequent insulin resistance ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

“…Milder et al emphasize cessation in case of bariatric surgeries with preoperative dietary changes and recommend to discontinue 1–2 weeks prior to surgery ( 75 ). Taking into account the half-life time of 8–16 h of SGLT2-I and the need for corporal elimination of about five half-lives, withholding 24–72 h might not be long enough to avoid EDKA ( 25 , 41 ). Therefore, the need for further studies to address this important and potential life-threatening complication of SGLT2-I use is obvious.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature

Kietaibl¹,

Fasching²,

Glaser³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

BackgroundEuglycemic diabetic ketoacidosis (EDKA) is a potentially life-threatening condition and a reported side effect of antidiabetic sodium-glucose-cotransporter-2-inhibitors (SGLT2-I). The analysis of the herein presented case and its management formed the incentive to prepare this multidisciplinary work and includes an overview about perioperative SGLT2-I-induced ketoacidosis.MethodA PubMed search on relevant entries was conducted combining the terms “euglycemic diabetic ketoacidosis” AND “surgery.”ResultsA total of 33 articles on SGLT2-I-induced ketoacidosis in the context of surgical treatment were identified. According to this literature research risk factors for the development are infection, perioperative fasting, surgical stress, and insulin dose reduction.ConclusionUnspecific symptoms mimicking acute abdomen and normoglycemia can lead to delayed diagnosis of EDKA and might harm patients under SGLT2-I therapy in the perioperative setting. SGLT2-I medication should be withheld for at least 24–48 h prior to surgery according to this review of literature and restarted only in stable clinical conditions to avoid the severe complication of EDKA.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature

Kietaibl¹,

Fasching²,

Glaser³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

show abstract

“…31 However, all preventive measures such as regular food and fluid intakes, tight glycaemic control, omission of SGLT2is, and ketone measurement at states of increased insulin requirement (due to illness, surgery, or alcohol abuse) should be taken into account. 1,[32][33][34] In the era of pandemics, it is important to suggest all treating physicians to temporarily omit SGLT2is, while the patients are recovering from the COVID-19 disease. 35 Comprehensive patient education plays an essential role in preventing potentially life-threatening euDKA.…”

Section: Discussionmentioning

confidence: 99%

Sodium–glucose cotransporter 2 inhibitor‐induced euglycaemic diabetic ketoacidosis in heart failure with preserved ejection fraction

et al. 2021

View full text Add to dashboard Cite

The number of patients receiving sodium-glucose cotransporter 2 inhibitors (SGLT2is), especially those with heart failure, is increasing worldwide. SGLT2is control glycaemia by triggering glycosuria with simultaneous facilitation of a more ketogenic metabolic profile. Patients therefore are more prone to develop euglycaemic diabetic ketoacidosis (euDKA), an entity largely unknown beyond diabetes care professionals. We present a heart failure with preserved ejection fraction (HFpEF) patient with known Type 2 diabetes. He was treated with dapagliflozin and presented acutely with dyspnoea, hyperglycaemia, and ketoacidosis. After standard treatment for diabetic ketoacidosis, hyperglycaemia was corrected, while metabolic ketoacidosis persisted, and thus, euDKA was suspected. With adequate therapy, the patient recovered completely and was discharged without any sequelae. To the best of our knowledge, our case is the first to describe SGLT2i-induced euDKA in HFpEF patients. Regarding no previous reports of euDKA in heart failure with reduced ejection fraction, our report is highly relevant for ongoing SGLT2i trials in HFpEF and clinical practice in general.

show abstract

Position statement: surgery and diabetes mellitus (Update 2023)

Kietaibl

Huber²,

Clodi

et al. 2023

Wien Klin Wochenschr

View full text Add to dashboard Cite

ZusammenfassungDas vorliegende Positionspapier beschreibt die Sicht der Österreichischen Diabetes Gesellschaft hinsichtlich des perioperativen Managements von Menschen mit Diabetes mellitus auf Basis der verfügbaren wissenschaftlichen Evidenz. Dabei wird Bezug genommen auf die präoperative Begutachtung und Vorbereitung sowie auf die perioperative Stoffwechselkontrolle mittels oraler Antidiabetika und/oder injektabler Therapie (Insulin‑/GLP-1-RA-therapie).

show abstract

Perioperative euglycemic diabetic ketoacidosis following use of SGLT-2 inhibitors after cardiac surgery

Cited by 8 publications

References 9 publications

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature

Sodium–glucose cotransporter 2 inhibitor‐induced euglycaemic diabetic ketoacidosis in heart failure with preserved ejection fraction

Position statement: surgery and diabetes mellitus (Update 2023)

Contact Info

Product

Resources

About