Euglycemic diabetic ketoacidosis induced by empagliflozin, sodium-glucose cotransporter-2 inhibitor, in patient with diabetes mellitus type 2 after thoracic surgery

Autori:

Jelena Magaš Vadlja, Jasna Špiček-Macan, Jadranka Katančić, Iva Milišić Jašarević, Vjekoslav Karadža, Marija Copić

Sažetak
Inhibitori kotransportera natrija i glukoze 2 (engl. Sodium-glucose cotransporter-2 inhibitors – SGLT2i) noviji su oralni antidijabetici koji mogu uzrokovati euglikemijsku dijabetičku ketoacidozu (eDKA), i to češće kod bolesnika sa šećernom bolesti tipa 1, a rijetko u onih s tipom 2 šećerne bolesti. Glavna karakteristika eDKA-a jest gotovo normalna razina glukoze u krvi (GUK) uz metaboličku ketoacidozu. U našem prikazu riječ je o 42-godišnjoj bolesnici u koje su se u ranome postoperativnom periodu, uz gotovo normalne vrijednosti GUK-a, razvili metabolička acidoza, povraćanje i pospanost. Sumnju da se radi o dijabetičkoj ketoacidozi potvrdio je, uz ostalo, pozitivan nalaz ketona u urinu. Na temelju kliničke slike, nalaza plinskih analiza arterijske krvi i laboratorijskih nalaza krvi i urina postavila se dijagnoza eDKA-a, nastalog kao posljedica SGLT2i-ja. Bolesnica je liječena inzulinom, kristaloidnim otopinama i elektrolitima. Trećega postoperativnog dana liječenja otpuštena je s Odjela anestezije i intenzivnog liječenja na Kirurški odjel, uz prethodni pregled endokrinologa. Rutinska perioperativna provjera plinskih analiza arterijske krvi pomogla nam je pri detekciji bolesti i liječenju bolesnice. Ovaj prikaz upućuje na važnost ranoga preoperativnog probira pacijenata na SGLT2i, mogući nastanak eDKA-a, važnost preoperativne pripreme i potrebe za liječenjem.
Summary

Sodium-glucose cotransporter-2 inhibitors(SGLT2i) medications are a class of newer antihyperglycemic agents that can induce euglycemic diabetic ketoacidosis (eDKA), usually in patients with diabetes mellitus type 1,but very rarely in patients with diabetes mellitus type 2. The main characteristic of eDKA is that blood glucose level(BGL) is nearly normal. We present a case report of a 42-year-old patient who was scheduled for elective thoracic surgery in which in the early postoperative period she developed metabolic acidosis with nausea and vomiting. Ketones in urine were positive and it was recognized as eDKA induced by SGLT2i. She was treated with intravenous insulin, fluids and electrolytes. She was dismissed from ICU on the third day to surgery department after endocrinologist´s review. Arterial blood gas samples are a part of our routine preoperative and postoperative procedures that helped us in the detection and treatment of this patient. This case report points out the importance of early recognition of patients on SGLT2i, appropriate preoperative assessment, and eventually the need for treatment.

Volumen: 1-2, 2020

Liječ Vjesn 2020;142:2–5

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