Prolonged acidosis is a feature of SGLT2i-induced euglycaemic diabetic ketoacidosis
| Autor: | Arslan Butt, Aiden Devitt, Francis M. Finucane, Lisa Reddington, Mohammed Faraz Rafey, Barry Coffey, David W.P. Lappin |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
pH (blood) Endocrinology Diabetes and Metabolism medicine.medical_treatment Empagliflozin Acanthosis nigricans White Type 2 diabetes Unusual effects of medical treatment Kidney Gastroenterology lcsh:Diseases of the endocrine glands. Clinical endocrinology Electrolytes 0302 clinical medicine Diabetes mellitus type 2 Ramipril Diabetic ketoacidosis Tachycardia Atorvastatin Insulin Tachypnoea Myasthaenia Estimated glomerular filtration rate Adrenal Fatigue September Dehydration Metabolic acidosis Dry mucous membranes Diabetes Nausea Anorexia Bicarbonate Nephrology 030220 oncology & carcinogenesis Gliclazide Female Lercanidipine SGLT2 inhibitors medicine.drug Adult Euglycemic Diabetic Ketoacidosis medicine.medical_specialty Acrochorda Insulin glargine Cardiology 030209 endocrinology & metabolism Glucose (blood) Urinalysis Syncope Ketones (plasma) Pregabalin 03 medical and health sciences BMI Ketones (urine) Internal medicine Diabetes mellitus Glucosuria Fluid repletion Dulaglutide Internal Medicine medicine Creatinine (serum) Sitagliptin Canagliflozin Haemoglobin A1c Insulin Aspart lcsh:RC648-665 Anion gap business.industry Doxazosin medicine.disease Ezetimibe Ketoacidosis Glucose Duloxetine Ketonuria Lactate Alpha-blockers Surgery business Hypoglycaemia Ireland |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-5 (2019) |
| ISSN: | 2052-0573 |
| Popis: | We describe two cases of SGLT2i-induced euglycaemic diabetic ketoacidosis, which took longer than we anticipated to treat despite initiation of our DKA protocol. Both patients had an unequivocal diagnosis of type 2 diabetes, had poor glycaemic control with a history of metformin intolerance and presented with relatively vague symptoms post-operatively. Neither patient had stopped their SGLT2i pre-operatively, but ought to have by current treatment guidelines. Learning points: SGLT2i-induced EDKA is a more protracted and prolonged metabolic derangement and takes approximately twice as long to treat as hyperglycaemic ketoacidosis. Surgical patients ought to stop SGLT2i medications routinely pre-operatively and only resume them after they have made a full recovery from the operation. While the mechanistic basis for EDKA remains unclear, our observation of marked ketonuria in both patients suggests that impaired ketone excretion may not be the predominant metabolic lesion in every case. Measurement of insulin, C-Peptide, blood and urine ketones as well as glucagon and renal function at the time of initial presentation with EDKA may help to establish why this problem occurs in specific patients. Patient Demographics: Adult, Female, Male, White, Ireland Clinical Overview: Adrenal, Kidney, Diabetes, Insulin, Diabetes mellitus type 2, Diabetic ketoacidosis, Euglycemic diabetic ketoacidosis*, Metabolic acidosis Diagnosis and Treatment: Diabetic ketoacidosis, Diabetes mellitus type 2, Euglycemic diabetic ketoacidosis*, Ketonuria, Metabolic acidosis, Nausea, Fatigue, Myasthaenia, Anorexia, Tachycardia, Tachypnoea, Dehydration, Glucosuria, Dry mucous membranes*, Acanthosis nigricans, Acrochorda, Syncope, Hypoglycaemia, Haemoglobin A1c, Glucose (blood), Urinalysis, Bicarbonate, pH (blood), Ketones (urine), Ketones (plasma), Lactate, Anion gap, BMI, Creatinine (serum), Estimated glomerular filtration rate, Electrolytes, Fluid repletion, SGLT2 inhibitors, Glucose, Atorvastatin, Canagliflozin, Dulaglutide*, Ezetimibe, Empagliflozin, Insulin glargine, Duloxetine*, Lercanidipine*, Doxazosin, Ramipril, Alpha-blockers, Pregabalin*, Insulin Aspart, Gliclazide, Sitagliptin Related Disciplines: Cardiology, Nephrology, Surgery Publication Details: Unusual effects of medical treatment, September, 2019 Background Sodium glucose-like transporter-2 inhibitor (SGLT2i) drugs have become widely prescribed for patients with type 2 diabetes (T2DM) because of their efficacy in improving glycaemic control (1), reducing cardiovascular and all-cause mortality (1) as well as improving renal (2) and cardiac (3) function in patients with chronic kidney disease and heart failure, respectively. Moreover, SGLT2is do not cause hypoglycaemia or weight gain, unlike some other diabetes medications. They inhibit the reabsorption of glucose from the renal filtrate, thus inducing glycosuria (4), which can commonly lead to genitourinary infections. In 2015, the first description of a rare and unanticipated complication of SGLT2i use, euglycaemic diabetic ketoacidosis (EDKA) was described, whereby patients with an unequivocal diagnosis of type 2 diabetes developed metabolic acidosis with very high levels of ketones consistent with DKA, but with normal glucose levels. While EDKA has been well described, with an incidence of approximately 0.1% in the EMPAREG (1) and CANVAS (5) randomised controlled trials (1, 5), its mechanistic basis is still not well established. It has been observed predominantly in hospitalised patients. Whether the duration of the metabolic acidosis is different from hyperglycaemic ketoacidosis has not been well described previously. We sought to describe our experience of the management of two patients with EDKA in whom the metabolic derangement took longer than expected to reverse. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|