Sodium-glucose Cotransporter-2 Inhibitors and Euglycaemic Diabetic Ketoacidosis in the Perioperative Period: Case Report

The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) has been steadily increasing over the past few years due to their efficacy in glycaemic control as well as added benefits of weight loss and reduction in cardiovascular mortality. SGLT2i are a class of oral hypoglycaemics that work by increasing urinary glucose excretion via the inhibition of the sodium-glucose cotransporter-2 in the proximal tubule of the kidney. Euglycaemic diabetic ketoacidosis (euDKA) is a potentially life-threatening adverse effect of SGLT2i. The literature shows an increasing awareness of this issue amongst physicians. However, in addition to prescriber education, emphasis needs to be placed on patient education to highlight this potentially serious adverse effect. We present two cases of patients with euDKA following SGLT2i use in the perioperative period. The cases discussed reiterate the importance of awareness of SGLT2i-induced euDKA during the perioperative period. Both cases raise the question of whether patients are being adequately educated about the drug, its adverse effects and under what conditions to cease the medication.