a Oklahoma Center for Poison and Drug Information , Oklahoma City , OK , USA.
b Illinois Poison Center , Chicago , IL , USA.
Clin Toxicol (Phila). 2018 Mar;56(3):204-208. doi: 10.1080/15563650.2017.1357824. Epub 2017 Aug 16.
SGLT2 inhibitors are a new class of oral antidiabetics prescribed in the United States since 2013. They act by inhibiting reabsorption of glucose in the proximal convoluted tubule of the kidney, allowing excess glucose to be excreted. Little has been reported regarding effects of non-therapeutic exposure to this class of medication.
Retrospective records from 13 poison centers were examined for human exposures to SGLT2 inhibitors between 1st January 2013 and 31st December 2016. Exclusion criteria included multi-substance exposures and exposures without any follow-up call. Data examined included patient age, chronicity of exposure, clinical effects, management site, treatments administered, duration of follow-up, and outcome.
Eighty-eight cases met inclusion criteria. Patient age ranged from 1 to 75 years; 49 were evaluated in a health care facility with 18 admissions. No symptoms developed in 80 (91%) patients, 6 (7%) developed minor symptoms, and 2 (2%) developed moderate symptoms. Hypoglycemia was not observed. Mean time to final follow-up was 9.3 h, ranging from 1 to 42 h; median was 6 h. Of the two patients who developed moderate symptoms, one was a 65 year old male who developed metabolic acidosis and hypokalemia while taking canagliflozin therapeutically; the other a 43-year-old female who developed tachycardia and mild hypertension following the intentional ingestion of 6000 mg of canagliflozin.
The number of patients evaluated in a health care facility is most likely reflective of a cautious approach to dealing with a new class of drug. Exposures were generally well-tolerated and managed with minimal intervention.
In this retrospective series, acute ingestions of SGLT2 inhibitors were well-tolerated with no hypoglycemia and only minor effects. For young children with unintentional ingestions, a reasonable approach to home management would include at least one follow-up for signs and symptoms of possible toxicity including mental status changes, polyuria, or tachypnea.
自 2013 年以来，SGLT2 抑制剂在美国被列为新型口服抗糖尿病药物。它们通过抑制肾脏近曲小管对葡萄糖的重吸收起作用，使多余的葡萄糖得以排泄。目前有关该类药物非治疗性暴露的影响的报道较少。
对 2013 年 1 月 1 日至 2016 年 12 月 31 日期间 13 个中毒中心的回顾性记录进行了检查，以确定 SGLT2 抑制剂的人体暴露情况。排除标准包括多物质暴露和无随访电话的暴露。检查的数据包括患者年龄、暴露的慢性程度、临床影响、管理地点、给予的治疗、随访时间和结果。
88 例符合纳入标准。患者年龄为 1 至 75 岁；49 例在医疗机构接受评估，其中 18 例住院。80 例（91%）患者无症状，6 例（7%）出现轻微症状，2 例（2%）出现中度症状。未观察到低血糖。最终随访的平均时间为 9.3 小时，范围为 1 至 42 小时；中位数为 6 小时。两名出现中度症状的患者中，一名 65 岁男性在接受卡格列净治疗时发生代谢性酸中毒和低钾血症；另一名 43 岁女性在故意摄入 6000 毫克卡格列净后出现心动过速和轻度高血压。
在医疗机构接受评估的患者数量可能反映了处理新型药物的谨慎态度。暴露通常耐受性良好，干预措施最少。
在本回顾性系列研究中，SGLT2 抑制剂的急性摄入耐受性良好，无低血糖，仅有轻微影响。对于意外摄入的幼儿，合理的家庭管理方法至少包括一次随访，以观察可能出现毒性的迹象和症状，包括精神状态改变、多尿或呼吸急促。
