Severe intoxication caused by sodium-glucose cotransporter 2 inhibitor overdose: a case report

Abstract

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors inhibit SGLT2, which is expressed in the proximal renal tubule, and thus reduce blood glucose levels by enabling the urinary excretion of excess glucose. SGLT2 inhibitors have been reported to suppress the complications of diabetes and reduce overall mortality. However, little is known about the types of symptoms that may occur in response to an overdose of an SGLT2 inhibitor. Here, we describe a case of intoxication caused by an overdose of an SGLT2 inhibitor. Case presentation: An otherwise physically healthy adult woman ingested an overdose of ipragliflozin, an SGLT2 inhibitor, and a polypill of olmesartan medoxomil, and azelnidipine in a suicide attempt. Although her blood ipragliflozin concentration was very high (9516.3 ng/mL) upon hospital arrival, her initial blood glucose level was normal, and she did not exhibit symptoms such as hypoglycemia or polyuria. Moderate renal dysfunction associated with an estimated glomerular filtration rate of 42.3 mL/min/1.73 m 2 was observed. Thirty-six hours after ingestion, her blood ipragliflozin concentration decreased to a level equivalent to that observed after a therapeutic dose and her renal function improved almost simultaneously. After improvement in her renal function, the osmotic diuretic effect of the drug progressed. Her blood glucose level declined slightly but was in the normal range due to glucose administration. During the clinical course, fatal hypoglycemia was not observed. Conclusions: Our case showed that an overdose of an SGLT2 inhibitor caused toxic effects on renal function, but severe hypoglycemia was not observed. Additional cases of intoxication from SGLT2 inhibitors alone would be helpful to clarify the mechanism of intoxication.

Sodium-Glucose Cotransporter-2 Inhibitors in Depression

“…Her kidney injury and hypotension resolved within 36 hours as her serum levels of ipragliflozin decreased from ten-times greater than therapeutic levels back to a normal therapeutic level. 107 Brain insulin resistance is thought to confer higher risk of depressive symptoms, and the association between type 2 diabetes and depression is well established. [108][109][110] Further clinical research on SGLT2 inhibitors in mood disorders would occur in the context of an expanding base of evidence for using medications developed for insulin resistance in psychiatric indications.…”

“…A single case report of a patient who attempted suicide with her mother’s SGLT2 inhibitor, ipragliflozin, and a polypill containing olmesartan, medoxomil, and azelnidipine noted that the patient presented with acute kidney injury and hypotension, but did not have polyuria or hypoglycemia. Her kidney injury and hypotension resolved within 36 hours as her serum levels of ipragliflozin decreased from ten-times greater than therapeutic levels back to a normal therapeutic level 107 …”