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SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report

Euglycemic diabetic ketoacidosis is a rare but serious adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of a woman in her 40s with type 2 diabetes mellitus hospitalized for revascularization for moyamoya disease who developed empagliflozin-associated euglycemic...

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Autores principales: Wang, Katherine M., Isom, Robert T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380362/
https://www.ncbi.nlm.nih.gov/pubmed/32734242
http://dx.doi.org/10.1016/j.xkme.2019.12.006
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author Wang, Katherine M.
Isom, Robert T.
author_facet Wang, Katherine M.
Isom, Robert T.
author_sort Wang, Katherine M.
collection PubMed
description Euglycemic diabetic ketoacidosis is a rare but serious adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of a woman in her 40s with type 2 diabetes mellitus hospitalized for revascularization for moyamoya disease who developed empagliflozin-associated euglycemic diabetic ketoacidosis despite having stopped the medication before admission. Surgical stress, acute postoperative illness, and decreased carbohydrate intake are postulated to be contributing factors to the development of ketosis in this patient, while near-normal glucose levels initially suggested nondiabetic ketoacidosis physiology and led to delayed diagnosis and treatment. Patients with type 2 diabetes mellitus may develop diabetic ketoacidosis during states of relative insulinopenia, most frequently from inadequate medication or intercurrent illness. During periods of carbohydrate deficiency, volume depletion, and upregulation of counter-regulatory stress hormones, SGLT2 inhibitor therapy can promote lipolysis and ketogenesis while maintaining euglycemia. Clinical considerations to ensure safe SGLT2 inhibitor therapy include appropriate holding parameters, timely diagnosis of euglycemic diabetic ketoacidosis, and recognition that the pharmacologic effects of SGLT2 inhibitor treatment may persist beyond several half-lives of elimination.
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spelling pubmed-73803622020-07-29 SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report Wang, Katherine M. Isom, Robert T. Kidney Med Case Report Euglycemic diabetic ketoacidosis is a rare but serious adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of a woman in her 40s with type 2 diabetes mellitus hospitalized for revascularization for moyamoya disease who developed empagliflozin-associated euglycemic diabetic ketoacidosis despite having stopped the medication before admission. Surgical stress, acute postoperative illness, and decreased carbohydrate intake are postulated to be contributing factors to the development of ketosis in this patient, while near-normal glucose levels initially suggested nondiabetic ketoacidosis physiology and led to delayed diagnosis and treatment. Patients with type 2 diabetes mellitus may develop diabetic ketoacidosis during states of relative insulinopenia, most frequently from inadequate medication or intercurrent illness. During periods of carbohydrate deficiency, volume depletion, and upregulation of counter-regulatory stress hormones, SGLT2 inhibitor therapy can promote lipolysis and ketogenesis while maintaining euglycemia. Clinical considerations to ensure safe SGLT2 inhibitor therapy include appropriate holding parameters, timely diagnosis of euglycemic diabetic ketoacidosis, and recognition that the pharmacologic effects of SGLT2 inhibitor treatment may persist beyond several half-lives of elimination. Elsevier 2020-02-22 /pmc/articles/PMC7380362/ /pubmed/32734242 http://dx.doi.org/10.1016/j.xkme.2019.12.006 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Wang, Katherine M.
Isom, Robert T.
SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report
title SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report
title_full SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report
title_fullStr SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report
title_full_unstemmed SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report
title_short SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report
title_sort sglt2 inhibitor–induced euglycemic diabetic ketoacidosis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380362/
https://www.ncbi.nlm.nih.gov/pubmed/32734242
http://dx.doi.org/10.1016/j.xkme.2019.12.006
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