Cargando…

Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin

Euglycemic diabetic ketoacidosis (EDKA) is an uncommon diabetic complication with increasing prevalence and is associated with the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i). We report the case of a 77-year-old female patient with type 2 diabetes mellitus, treated with metformin/lina...

Descripción completa

Detalles Bibliográficos
Autores principales: Fustiga, João, Fernandes, Marco, Dâmaso, Francisca, Duarte, Joana A, Rodrigues, Catarina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9885381/
https://www.ncbi.nlm.nih.gov/pubmed/36726923
http://dx.doi.org/10.7759/cureus.33161
_version_ 1784879919173468160
author Fustiga, João
Fernandes, Marco
Dâmaso, Francisca
Duarte, Joana A
Rodrigues, Catarina
author_facet Fustiga, João
Fernandes, Marco
Dâmaso, Francisca
Duarte, Joana A
Rodrigues, Catarina
author_sort Fustiga, João
collection PubMed
description Euglycemic diabetic ketoacidosis (EDKA) is an uncommon diabetic complication with increasing prevalence and is associated with the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i). We report the case of a 77-year-old female patient with type 2 diabetes mellitus, treated with metformin/linagliptin and empagliflozin, who initiated a slurred speech and altered level of consciousness in the postoperative period of a cholecystectomy. On observation, the patient presented with Kussmaul breathing and mucosal dryness and was ketotic. Laboratory exams showed metabolic acidosis with an elevated anion gap, normoglycemia, and positive ketonemia. Fluid replacement with dextrose solution and continuous insulin infusion were initiated, with progressive clinical and laboratory improvement. On discharge, she showed resolution of symptoms, and empagliflozin was discontinued from her usual medication. Despite the warnings of European and American medical agencies in 2015/2016, EDKA remains a challenging diagnosis due to its unspecific and insidious symptoms.
format Online
Article
Text
id pubmed-9885381
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-98853812023-01-31 Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin Fustiga, João Fernandes, Marco Dâmaso, Francisca Duarte, Joana A Rodrigues, Catarina Cureus Emergency Medicine Euglycemic diabetic ketoacidosis (EDKA) is an uncommon diabetic complication with increasing prevalence and is associated with the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i). We report the case of a 77-year-old female patient with type 2 diabetes mellitus, treated with metformin/linagliptin and empagliflozin, who initiated a slurred speech and altered level of consciousness in the postoperative period of a cholecystectomy. On observation, the patient presented with Kussmaul breathing and mucosal dryness and was ketotic. Laboratory exams showed metabolic acidosis with an elevated anion gap, normoglycemia, and positive ketonemia. Fluid replacement with dextrose solution and continuous insulin infusion were initiated, with progressive clinical and laboratory improvement. On discharge, she showed resolution of symptoms, and empagliflozin was discontinued from her usual medication. Despite the warnings of European and American medical agencies in 2015/2016, EDKA remains a challenging diagnosis due to its unspecific and insidious symptoms. Cureus 2022-12-31 /pmc/articles/PMC9885381/ /pubmed/36726923 http://dx.doi.org/10.7759/cureus.33161 Text en Copyright © 2022, Fustiga et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Fustiga, João
Fernandes, Marco
Dâmaso, Francisca
Duarte, Joana A
Rodrigues, Catarina
Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin
title Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin
title_full Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin
title_fullStr Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin
title_full_unstemmed Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin
title_short Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin
title_sort postop complication with euglycemic diabetic ketoacidosis in a patient receiving empagliflozin
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9885381/
https://www.ncbi.nlm.nih.gov/pubmed/36726923
http://dx.doi.org/10.7759/cureus.33161
work_keys_str_mv AT fustigajoao postopcomplicationwitheuglycemicdiabeticketoacidosisinapatientreceivingempagliflozin
AT fernandesmarco postopcomplicationwitheuglycemicdiabeticketoacidosisinapatientreceivingempagliflozin
AT damasofrancisca postopcomplicationwitheuglycemicdiabeticketoacidosisinapatientreceivingempagliflozin
AT duartejoanaa postopcomplicationwitheuglycemicdiabeticketoacidosisinapatientreceivingempagliflozin
AT rodriguescatarina postopcomplicationwitheuglycemicdiabeticketoacidosisinapatientreceivingempagliflozin