scholarly journals Sodium-glucose cotransporter-2-induced euglycemic diabetic ketoacidosis unmasks latent autoimmune diabetes in a patient misdiagnosed with type 2 diabetes mellitus: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Brian Vadasz ◽  
Mattan Arazi ◽  
Yousef Shukha ◽  
Ofir Koren ◽  
Riad Taher
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Autoimmune Diabetes ◽  
Serum Glucose ◽  
Glucose Levels ◽  
Latent Autoimmune Diabetes ◽  
Sodium Glucose Cotransporter ◽  
Life Threatening ◽  
Euglycemic Diabetic Ketoacidosis

Abstract Background Euglycemic diabetic ketoacidosis is an uncommon but life-threatening complication associated with the use of sodium-glucose cotransporter 2 inhibitors that causes lower than expected blood glucose levels typically seen in diabetic ketoacidosis. Case presentation We present a case of 64-year-old Caucasian male patient previously diagnosed with type 2 diabetes treated with a sodium-glucose cotransporter 2 inhibitor who developed severe ketoacidosis. Serum glucose levels on initial presentation were slightly above normal baseline level. The patient was revealed to have latent autoimmune diabetes in adults. Conclusion This case highlights the importance of prescribing sodium-glucose cotransporter 2 inhibitors to the correct patient population and the significance of accurately differentiating between various types of diabetes.

scholarly journals Euglycemic Diabetic Ketoacidosis Precipitated by SGLT-2 Inhibitor Use, Pericarditis, and Fasting: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 389-392
Author(s):  
Rebecca Mendelsohn ◽  
Anabelle Taveras ◽  
Benjamin Mazer ◽  
Lisa Clayton
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Oral Intake ◽  
Serum Glucose ◽  
Acute Pericarditis ◽  
Sodium Glucose Cotransporter ◽  
Life Threatening ◽  
Underlying Causes ◽  
Euglycemic Diabetic Ketoacidosis

Introduction: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Less prevalent is euglycemic DKA (eDKA)—DKA with serum glucose less than 200 mg/dL; however, it is increasing in frequency with the introduction of sodium glucose cotransporter 2 (SGLT-2) inhibitors for treatment of type 2 diabetes. Case Report: We report a case of SGLT-2 inhibitor-associated eDKA presenting with concurrent acute pericarditis. Discussion: Our case suggests that the cause of eDKA can be multifactorial when decreased oral intake occurs in the setting of an acute cause of physiologic stress. Conclusion: Prompt recognition of eDKA in the emergency department may allow earlier diagnosis and treatment directed at one or more of its underlying causes.

scholarly journals Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis

2021 ◽  
Vol 11 (2) ◽  
pp. 216-218
Author(s):  
Marta Brandão Calçada ◽  
Luís Fernandes ◽  
Rita Soares Costa ◽  
Sara Montezinho ◽  
Filipa Martins Duarte ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Drug Class ◽  
Clinical Suspicion ◽  
Laboratory Findings ◽  
Sodium Glucose Cotransporter ◽  
History Of ◽  
High Degree ◽  
Euglycemic Diabetic Ketoacidosis

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

scholarly journals Paradoxical Diabetic Ketoacidosis in a Type 2 Diabetes patient on Dapagliflozin: A Brief Case Report

2021 ◽  
Author(s):  
Venkata Vinod Kumar Matli
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Diabetes Patient ◽  
Glucose Levels ◽  
Normal Glucose ◽  
Euglycemic Diabetic Ketoacidosis ◽  
Insulin Replacement

A 48-year -old male patient with Type 2 diabetes mellitus(T2D) on insulin replacement therapy, glipizide and Dapagliflozin admitted for generalized weakness found him in euglycemic diabetic ketoacidosis which means normal or near normal glucose levels with high anion gap metabolic acidosis recovered on insulin drip per DKA protocol.

Euglycemic Diabetic Ketoacidosis A Dreaded Complication in Post-Operative Patients In ICU

2020 ◽  
Vol 7 (1) ◽  
pp. 34-36
Author(s):  
Dr. Wasim Feroz ◽  
Dr. Sandeep Nale ◽  
Dr. H S Rawat
Keyword(s):  
Diabetic Ketoacidosis ◽  
Blood Sugar ◽  
Interbody Fusion ◽  
Ketone Bodies ◽  
Posterior Lumbar Interbody Fusion ◽  
Serum Glucose ◽  
Glucose Levels ◽  
Life Threatening ◽  
Sugar Levels ◽  
Euglycemic Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life threatening metabolic disorder and a known complication of Diabetes mellitus, caused by insulin deficiency or insulin resistance, which allows the catabolism of free fatty acids into ketone bodies, with high blood sugar levels. A rare variant of it is, euglycemic diabetic ketoacidosis (EKDA). We report a case of 60 year old female who was posted for Posterior lumbar interbody fusion (PLIF) and had this complication postoperatively. We believe that this case would serve as a reminder to all practitioners and intensivist to consider ketosis in a diabetic patient despite their serum glucose levels being within the normal range and all anaesthetist to consider the use of insulin during the intra op period even the blood sugar level is normal in peri operative period. This case report summarizes, in brief, the etiology, pathophysiology and treatment of EDKA.

scholarly journals Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 462 ◽  
Author(s):  
Felice Nappi ◽  
Antonietta La Verde ◽  
Giovanni Carfora ◽  
Carlo Garofalo ◽  
Michele Provenzano ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Sglt2 Inhibitor ◽  
Delayed Diagnosis ◽  
Kidney Injury ◽  
Dialysis Unit ◽  
New Class ◽  
Sodium Glucose Cotransporter ◽  
Euglycemic Diabetic Ketoacidosis

Euglycemic diabetic ketoacidosis (euDKA) related to sodium-glucose cotransporter 2 inhibitor (SGLT2-I), despite being reported as consistent, though infrequent, adverse effect in all trials on SGLT2-I in type 2 diabetes mellitus (T2D), still remains poorly known in the real world. On the other hand, the use of this new class of antihyperglycemic agents is expected to increase based on the recent solid evidence of remarkable cardiorenal protection. Therefore, improving awareness on risk factors, diagnosis, and treatment of euDKA is essential to allow correct implementation of SGLT2-I in clinical practice. We here report a T2D patient admitted to the emergency department and then transferred to the nephrology-dialysis unit because of severe euglycemic diabetic ketoacidosis (euDKA) related to sodium-glucose cotransporter 2 inhibitor (SGLT2-I). In our patient, a concurrent acute kidney injury at presentation, initially attributed to excessive use of nonsteroid anti-inflammatory agents, and the absence of severe hyperglycemia led to delayed diagnosis and proper therapy. The detailed description of decision-making process for diagnosis and therapy, and the analysis of precipitating factors as well, discloses the helpful contribution of nephrologist to optimize prevention and management of euDKA.

scholarly journals Sodium–glucose cotransporter 2 inhibitor-induced euglycemic diabetic ketoacidosis in a patient with coronavirus disease 2019: a case report

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Edwin Sze Sian Yii ◽  
Athirah Wan Azli ◽  
Premela Naidu Sitaram
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Oral Antihyperglycemic Agents ◽  
Intravenous Insulin ◽  
Sodium Glucose Cotransporter ◽  
High Index Of Suspicion ◽  
Euglycemic Diabetic Ketoacidosis

Abstract Background Sodium–glucose cotransporter 2 inhibitors are among the new-generation oral antihyperglycemic agents that have been used in the treatment of type 2 diabetes mellitus. With the recent coronavirus disease 2019 pandemic and rise of cases in the third wave, diagnosis of life-threatening euglycemic diabetic ketoacidosis may easily be overlooked or missed. Case presentation We present the case of a 37-year-old Malay gentleman with underlying type 2 diabetes mellitus on empagliflozin, who presented to our hospital with symptomatic coronavirus disease 2019 infection and diabetic ketoacidosis. He developed severe rebound euglycemic diabetic ketoacidosis due to the continuous usage of empagliflozin for glycemic control alongside intravenous insulin. Conclusions Physicians should have a high index of suspicion in diagnosing and managing euglycemic diabetic ketoacidosis, including withholding treatment of sodium–glucose cotransporter 2 inhibitors during the acute management of diabetic ketoacidosis.

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