Euglycemic diabetic ketoacidosis: The clinical concern of SGLT2 inhibitors
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- 作者：Jamila A. Benmoussa ; MD ; Jabenmoussa@rumcsi.org ; jbenmous@gmail.com ; Matthew Clarke ; MD ; Amulya Penmetsa ; MS4 ; Le Yu Khine ; MD ; Lina Leykina ; MD ; Keith Diaz ; MD ; Philip Otterbeck ; MD
- 关键词：SGLT-2 inhibitors ; Canagliflozin ; Euglycemic DKA ; Near normal glucose level ; Glutamic Acid Decarboxylase autoantibodies ; Latent Autoimmune Diabetes of Adult onset (LADA)
- 刊名：Journal of Clinical and Translational Endocrinology: Case Reports
- 出版年：2016
- 出版时间：December 2016
- 年：2016
- 卷：2
- 期：Complete
- 页码：17-19
- 全文大小：194 K
- 卷排序：2
文摘
Euglycemic diabetic ketoacidosis is a post market warning in patients with type 1 diabetes and type 2 diabetes treated with SGLT-2 inhibitors. We report a case of a 39-year-old obese female with presumed type 2 diabetes for seven years who presented to the emergency department with three days of nausea, vomiting, and abdominal pain. Due to previous total non-adherence with a prescribed insulin regimen, she was recently started on canagliflozin and liraglutide. The diagnosis of euDKA was missed in the initial evaluation as the blood glucose level was only 167 mg/dL. Further work up showed severe metabolic acidosis with an anion gap of 25 and positive ketones in the urine. She was treated successfully with dextrose water 5%/half normal saline and an insulin drip. As part of the work up, she tested positive for glutamic acid decarboxylase autoantibodies.Given the increasing utilization of SGLT-2 inhibitors and the fact that patients can present with near-normal glycemia, the diagnosis can be missed. Vigilance with the use of SGLT-2 inhibitors is necessary to decrease morbidity and potentially mortality particularly in patients with long-standing type 2 diabetes associated with marked β-cell insufficiency, type 1 diabetes mellitus, or latent autoimmune diabetes of adult onset.