Abstract: SA-PO287
Euglycemic Diabetic Ketoacidosis Caused by a Sodium Glucose Cotransporter-2 Inhibitor
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 602 Diabetic Kidney Disease: Clinical
Authors
- Hettenbaugh, Jacob A., University of Nebraska Medical Center, Omaha, Nebraska, United States
- Syed, Faizan, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Westphal, Scott G., University of Nebraska Medical Center-Nebraska Medicine, Omaha, Nebraska, United States
Introduction
The use of Sodium Glucose Cotransporter-2 (SGLT-2) Inhibitors in the treatment of diabetes mellitus has continued to grow in the last several years, owing to their ability to reduce cardiovascular morbidity and mortality, and prevent incident or progressive diabetic nephropathy. With their increasing use, providers must understand the side effect profile of this new drug class. Here, we present a case of euglycemic diabetic ketoacidosis secondary to empaglliflozin, which is a rare, but potentially life threatening complication of SGLT-2 inhibitors.
Case Description
A 53-year-old man with type 2 diabetes mellitus managed with metformin and empagliflozin, presented with progressive nausea and vomiting, and was found to have a severe anion gap metabolic acidosis. On presentation, his pH was 7.11, serum bicarbonate 5 mmol/L, and anion gap was severely elevated. His blood glucose was 184 mg/dl. Beta-hydroxybutryate was markedly elevated, serum lactate was normal at 0.8 mmol/L, and serum creatinine was 1.0 mg/dl. He was diagnosed with non-hyperglycemic diabetic ketoacidosis based on strong clinical suspicion. Although glucose was < 200 mg/dl, he was treated with IV insulin and withdrawal of his empagliflozin. Within two days his acidemia had resolved with serum pH improving to 7.37, serum bicarbonate increasing to 24 mmol/L, and resolution of his anion gap.
Discussion
Ketoacidosis is a rare complication of SGLT-2 inhibitors. Unlike diabetic ketoacidosis in patients with type 1 diabetes mellitus, patients taking SGLT-2 inhibitors do not present with overt hyperglycemia. Due to this, ketoacidosis may go unrecognized leading to a delay in diagnosis and therapy. The cause of this complication is assumed to be due to decreased insulin production and loss of regulation of glucagon leading to increased glucagon secretion. As many nephrologists are now using SGLT-2 inhibitors regularly in patients with type 2 diabetes mellitus, providers need to be aware of this rare, but potentially serious complication in order to make a prompt diagnosis and institute timely treatment.