NDLI: Euglycemic diabetic ketoacidosis caused by canagliflozin: a case report

Content Provider	Springer Nature : BioMed Central
Author	Fukuda, Masafumi Nabeta, Masakazu Muta, Takanori Fukami, Kei Takasu, Osamu
Abstract	Background Diabetic ketoacidosis (DKA) is seen relatively frequently in the emergency department (ED). DKA is characterized by hyperglycemia, acidosis, and ketonemia, and sodium glucose transporter 2 inhibitors (SGLT2i) represent a new diabetes medication that has been associated with euglycemic DKA (eu-DKA). Case presentation A 71-year-old female who was being treated for type 2 diabetes with canagliflozin, metformin, and saxagliptin orally presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain. Although her blood glucose was not severely elevated (259 mg/dL), there was notable ketoacidosis (pH 6.89; CO2, 11.4 mmHg; HCO3, 1.9 mEq/L; base excess, − 31.3 mmol/L; 3-hydroxybutyric acid > 10,000 μmol/L) was observed. The uncontrolled acidosis improved following 3 days of continuous renal replacement therapy, but elevated urinary glucose continued for more than 10 days. Ringer’s lactated fluid supplementation was continued for management of polyurea and glucosuria. Urinary glucose turned negative on day 16, and there was improvement in the patient’s overall state; hence, she was discharged on day 18. Conclusion Although it is difficult to diagnose eu-DKA because of the absence of substantial blood glucose abnormalities in the ED, there is a need to consider eu-DKA when evaluating acidosis in a patient treated with SGLT2i. Moreover, even after discontinuing the SGLT2i, attention should be given to the possibility of continuing glucosuria. Regular measurements of urinary glucose should be obtained, and the patient should be monitored for dehydration.
Related Links	https://intjem.biomedcentral.com/counter/pdf/10.1186/s12245-020-0261-8.pdf
Ending Page	4
Page Count	4
Starting Page	1
File Format	HTM / HTML
ISSN	18651380
DOI	10.1186/s12245-020-0261-8
Journal	International Journal of Emergency Medicine
Issue Number	1
Volume Number	13
Language	English
Publisher	BioMed Central
Publisher Date	2020-01-22
Access Restriction	Open
Subject Keyword	Emergency Medicine Internal Medicine Cardiology Angiology Pediatrics Canagliflozin Sodium glucose cotransporter 2 inhibitors (SGLT2i) Euglycemic diabetic ketoacidosis (eu-DKA)
Content Type	Text
Resource Type	Case study
Subject	Emergency Medicine

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