Euglycemic Diabetic Ketoacidosis Post Bariatric Surgery in Type II DM in the Setting of SGLT2-Inhibitor Use
| Autor: | Khalid Alfares, Harish Gidda, Nikoletta Proudan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Canagliflozin
Pediatrics medicine.medical_specialty Past medical history Diabetes Case Reports Diabetic ketoacidosis business.industry Endocrinology Diabetes and Metabolism medicine.disease Diabetes Mellitus and Glucose Metabolism Discontinuation Lixisenatide chemistry.chemical_compound chemistry medicine Endocrine system Elective surgery Ketosis business AcademicSubjects/MED00250 medicine.drug |
| Zdroj: | Journal of the Endocrine Society |
| ISSN: | 2472-1972 |
| DOI: | 10.1210/jendso/bvab048.775 |
| Popis: | Introduction: Current AACE recommendations is to stop the SGLT-2 inhibitor at least 24 hours prior to elective surgery, planned invasive procedures, or anticipated severe stressful physical activity. However, case reports suggest that the pharmacologic effects of SGLT2 inhibitors persist beyond 5 half-lives of elimination (2–3 days), with glucosuria and ketonemia lasting as long as 9 to 10 days after discontinuation. Case: A 51 year old female with a past medical history of hypertension, morbid obesity, DM type II, admitted to the hospital electively for bariatric surgery. Post-op day 1, she became tachypneic and lethargic. However, alert, oriented and responding appropriately. Lab work showed blood glucose levels 500 mg/dl (0 mg/dl) and ketones 80 mg/dl (0 mg/dl). She was transferred to SICU. After reviewing her home medications, she was on Canagliflozin which was stopped 2 days prior to surgery and Glargine/Lixisenatide which was stopped 2 weeks prior to surgery as recommended by her endocrinologist. Patient was then diagnosed with euglycemic DKA. She was started on an insulin drip following potassium replacement and IV fluids. Over the course of few days, she started to feel better. Her PH, bicarb, anion gap and potassium all trended toward normal limits. She was transitioned off insulin drip to basal-bolus insulin regimen and then she was discharged on post-operative day 7 with the instruction to not take any SGLT2 inhibitors. Discussion: SGLT-2 inhibitors is known to cause euglycemic DKA and ketosis. Our case brings to attention that discontinuation of SGLT2 inhibitor treatment 48 hours prior to surgery may not be adequate specially giving the half-life of the medication. The optimal timing of discontinuation remains unknown. Further studies are needed to evaluate if longer withholding period may be necessary (1). 1.Yehuda Handelsman, Robert R. Henry, Zachary T. Bloomgarden, Sam Dagogo-Jack, Ralph A. DeFronzo, Daniel Einhorn, Ele Ferrannini, Vivian A. Fonseca, Alan J. Garber, George Grunberger, Derek LeRoith, Guillermo E. Umpierrez, and Matthew R. Weir (2016) AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF SGLT-2 INHIBITORS AND DIABETIC KETOACIDOSIS. Endocrine Practice: June 2016, Vol. 22, No. 6, pp. 753–762. |
| Databáze: | OpenAIRE |
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