Lane Sophia, Paskar David, Hamed Shatha, Goffi Alberto
From the Department of Anesthesia.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
A A Pract. 2018 Jul 15;11(2):46-48. doi: 10.1213/XAA.0000000000000734.
A 42-year-old woman with diabetes mellitus type 2 treated with the sodium-glucose cotransporter-2 inhibitor canagliflozin underwent elective bariatric gastric bypass. The canagliflozin was held for 24 hours preoperatively. She physiologically decompensated on postoperative day 2. Ultimately, she was diagnosed with euglycemic diabetic ketoacidosis that required intensive care management. This diagnosis was challenging to make as the patient never became hyperglycemic. We use this case to discuss the pharmacology and potential risk of perioperative sodium glucose cotransporter-2 inhibitor administration and to advocate for revision of current guidelines regarding the perioperative management of these agents.
一名42岁的2型糖尿病女性患者，正在接受钠-葡萄糖协同转运蛋白2抑制剂卡格列净治疗，接受了择期减重胃旁路手术。卡格列净在术前停用24小时。她在术后第2天出现生理代偿失调。最终，她被诊断为正常血糖性糖尿病酮症酸中毒，需要重症监护管理。由于患者从未出现高血糖，因此这一诊断颇具挑战性。我们通过这个病例来讨论围手术期使用钠-葡萄糖协同转运蛋白2抑制剂的药理学及潜在风险，并主张修订关于这些药物围手术期管理的现行指南。
