1 research outputs found
Euglycemic diabetic ketoacidosis induced by empagliflozin, sodium-glucose cotransporter-2 inhibitor, in patient with diabetes mellitus type 2 after thoracic surgery
Inhibitori kotransportera natrija i glukoze 2 (engl. Sodium-glucose cotransporter-2 inhibitors ā SGLT2i) noviji su oralni antidijabetici koji mogu uzrokovati euglikemijsku dijabetiÄku ketoacidozu (eDKA), i to ÄeÅ”Äe kod bolesnika sa Å”eÄernom bolesti tipa 1, a rijetko u onih s tipom 2 Å”eÄerne bolesti. Glavna karakteristika eDKA-a jest gotovo normalna razina glukoze u krvi (GUK) uz metaboliÄku ketoacidozu. U naÅ”em prikazu rijeÄ je o 42-godiÅ”njoj bolesnici u koje su se u ranome postoperativnom periodu, uz gotovo normalne vrijednosti GUK-a, razvili metaboliÄka acidoza, povraÄanje i pospanost. Sumnju da se radi o dijabetiÄkoj ketoacidozi potvrdio je, uz ostalo, pozitivan nalaz ketona u urinu. Na temelju kliniÄke slike, nalaza plinskih analiza arterijske krvi i laboratorijskih nalaza krvi i urina postavila se dijagnoza eDKA-a, nastalog kao posljedica SGLT2i-ja. Bolesnica je lijeÄena inzulinom, kristaloidnim otopinama i elektrolitima. TreÄega postoperativnog dana lijeÄenja otpuÅ”tena je s Odjela anestezije i intenzivnog lijeÄenja na KirurÅ”ki odjel, uz prethodni pregled endokrinologa. Rutinska perioperativna provjera plinskih analiza arterijske krvi pomogla nam je pri detekciji bolesti i lijeÄenju bolesnice. Ovaj prikaz upuÄuje na važnost
ranoga preoperativnog probira pacijenata na SGLT2i, moguÄi nastanak eDKA-a, važnost preoperativne pripreme i potrebe za lijeÄenjem.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 endocrinologistĀ“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