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Euglycemic Ketoacidosis as a Complication of SGLT2 Inhibitor Therapy
Journal article   Open access   Peer reviewed

Euglycemic Ketoacidosis as a Complication of SGLT2 Inhibitor Therapy

Biff F Palmer and Deborah J Clegg
Clinical journal of the American Society of Nephrology, v 16(8), pp 1284-1291
Aug 2021
DOI: https://doi.org/10.2215/CJN.17621120
PMID: 33563658
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://cjasn.asnjournals.org/content/clinjasn/16/8/1284.full.pdfView
Published, Version of Record (VoR) Open

Abstract

Blood Glucose - metabolism Humans Ketosis - blood Ketosis - chemically induced Ketosis - physiopathology Ketosis - therapy Kidney - drug effects Kidney - physiopathology Risk Factors Sodium-Glucose Transporter 2 Inhibitors - adverse effects
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are drugs designed to lower plasma glucose concentration by inhibiting Na -glucose-coupled transport in the proximal tubule. Clinical trials demonstrate these drugs have favorable effects on cardiovascular outcomes to include slowing the progression of CKD. Although most patients tolerate these drugs, a potential complication is development of ketoacidosis, often with a normal or only a minimally elevated plasma glucose concentration. Inhibition of sodium-glucose cotransporter-2 in the proximal tubule alters kidney ATP turnover so that filtered ketoacids are preferentially excreted as Na or K salts, leading to indirect loss of bicarbonate from the body and systemic acidosis under conditions of increased ketogenesis. Risk factors include reductions in insulin dose, increased insulin demand, metabolic stress, low carbohydrate intake, women, and latent autoimmune diabetes of adulthood. The lack of hyperglycemia and nonspecific symptoms of ketoacidosis can lead to delays in diagnosis. Treatment strategies and various precautions are discussed that can decrease the likelihood of this complication.

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84 citations in Web of Science
82 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Urology & Nephrology
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