scholarly journals Euglycemic Diabetic Ketoacidosis in Concurrent Very Low-carbohydrate Diet and Sodium-glucose Transporter-2 Inhibitor Use: A Case Report

2020 ◽  
Vol 4 (2) ◽  
pp. 185-188
Author(s):  
Matthew Earle ◽  
Brian Ault ◽  
Caitlin Bonney

Introduction: With the incredibly high incidence of Type 2 Diabetes in the current population of emergency department patients, it is critical for clinicians to understand the possible complications of the treatment of this disease. Medication like canagliflozin are more common to encounter on patient’s home medication lists and clinicians should be aware of how these medications, alone or combined with dietary modifications, can result in significant pathology and even mortality if not appropriately treated. Case Report: We report a case of a patient with type II diabetes mellitus who presented with euglycemic diabetic ketoacidosis in the setting of concurrent use of canagliflozin, a sodium-glucose transporter-2 (SGLT-2) inhibitor, and strict adherence to a low-carbohydrate ketogenic diet for weight control. Discussion: Euglycemic ketoacidosis has previously been observed in both diabetic and non-diabetic patients following strict ketogenic diets, as well as in diabetic patients being treated with SGLT-2 inhibitors. Conclusion: As more patients choose ketogenic diets for weight control and diabetes management, clinicians should be aware of this potentially life-threatening complication in patients concurrently taking SGLT-2 inhibitors.

2019 ◽  
Vol 139 (11) ◽  
pp. 1479-1483 ◽  
Author(s):  
Mariko Yamamoto ◽  
Naohito Ide ◽  
Shinzo Kitajima ◽  
Masakazu Obayashi ◽  
Kei Asada ◽  
...  

Author(s):  
Brenda Dorcely ◽  
Juliana Nitis ◽  
Arthur Schwartzbard ◽  
Jonathan Newman ◽  
Ira Goldberg ◽  
...  

Introduction: Sodium-glucose cotransporter-2 [SGLT2] inhibitors reduce cardiovascular events and mortality in patients with diabetes, particularly patients with established cardiovascular disease. Euglycemic diabetic ketoacidosis [euDKA], a complication of SGLT2 therapy, can be exacerbated by a low carbohydrate diet. Case Report: A 61-year-old man with a history of type 2 diabetes, taking a SGLT2 inhibitor empagliflozin 10 mg orally daily, presented to the emergency room with a 2-day history of nausea and chest pain. A week prior to presentation, he had started a ketogenic diet. He was initially admitted with a diagnosis of acute coronary syndrome. On initial assessment in the emergency room, his cardiac enzymes were normal and there were no ischemic changes in his ECG. As there was concern for unstable angina, he underwent cardiac catheterization, which showed a known total occlusion with collaterals and arteries with non-obstructive disease without evidence of acute plaque rupture. His baseline laboratory assessments revealed an elevated anion gap of 17, increased urinary and plasma ketones, and metabolic acidosis. His plasma glucose level was 84 mg/dL. The diagnosis of euDKA was made, and treatment with intravenous fluids and insulin was initiated. His chest pain and nausea subsequently resolved. Conclusion: We present a case of euDKA triggered by a ketogenic diet while on SGLT2 inhibitor therapy presenting as chest pain. The recognition of euDKA is important in the context of increased SGLT2 use for management of cardiovascular risk for patients with diabetes.


CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A981-A982
Author(s):  
Parth Patel ◽  
Tarang Patel ◽  
SACHIN PATIL ◽  
Shaili Patel ◽  
Jonathan Ross Ang

2017 ◽  
Vol 02 (02) ◽  
Author(s):  
Hiroshi Bando ◽  
Koji Ebe ◽  
Tetsuo Muneta ◽  
Masahiro Bando ◽  
Yoshikazu Yonei

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