Letter/Communication
Sodium–glucose linked transporter 2 inhibitor– associated perioperative euglycaemic diabetic ketoacidosis: a case for a perioperative guideline
Anaesthesia and intensive care, v 45(6), pp 758-759
01 Nov 2017
PMID: 29137588
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Sodium-glucose linked transporter 2 (SGLT2) is a glucose resorption mediator in the proximal convoluted tubule in the kidney. Pharmacologic inhibition of this transport protein increases glycosuria thus lowering blood glucose levels1. Limited safety and efficacy data has led to the Food and Drug Administration (FDA) approving SGLT2 inhibitor use for type 2 diabetes mellitus (T2DM) only. The FDA recently warned that SGLT2 inhibitor administration can result in diabetic ketoacidosis (DKA)2. A less common variation of this outcome is the reported incidence of euglycaemic DKA (euDKA), where ketoacidosis presents with a blood glucose level of less than 13.9 mmol/l. This rare complication is reported on an individual case basis, but highlights a severe adverse effect more difficult to detect3. Subsequent recommendations from the American Association of Clinical Endocrinologists and the American College of Endocrinology include a 24-hour cessation of SGLT2 inhibitors prior to surgery4. The European Medicines Agency implores vigilance in assessing serum ketones when atypical symptoms present despite normoglycaemia5. We report a case of euDKA in a patient who withheld her usual SGLT2 inhibitor on the day of surgery, and discuss future perioperative recommendations. Written informed consent for publication was obtained from the patient.
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Details
- Title
- Sodium–glucose linked transporter 2 inhibitor– associated perioperative euglycaemic diabetic ketoacidosis: a case for a perioperative guideline
- Creators
- C HoffmanM GreenO Megafu
- Publication Details
- Anaesthesia and intensive care, v 45(6), pp 758-759
- Publisher
- Sage Publications Ltd
- Resource Type
- Letter/Communication
- Language
- English
- Academic Unit
- Anesthesiology and Perioperative Medicine
- Web of Science ID
- WOS:000417226900017
- Scopus ID
- 2-s2.0-85101116346
- Other Identifier
- 991019174888004721
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- Web of Science research areas
- Anesthesiology
- Critical Care Medicine