Yeo Sang Mok, Park Hayeon, Paek Jin Hyuk, Park Woo Yeong, Han Seungyeup, Park Sung Bae, Jin Kyubok
Department of Internal Medicine, Keimyung University School of Medicine.
Keimyung University Kidney Institute, Daegu, Korea.
Medicine (Baltimore). 2019 Jan;98(3):e14150. doi: 10.1097/MD.0000000000014150.
Dapagliflozin (a sodium-glucose cotransporter-2 [SGLT2] inhibitor) represents the most recently approved class of oral medications for the treatment of type 2 diabetes. Dapagliflozin lowers plasma glucose concentration by inhibiting the renal reuptake of glucose in the proximal renal tubules. In 2015, the US Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis in patients taking this medication.
We present the case of a 23-year-old woman with type 2 diabetes treated with dapagliflozin (10 mg, once a day) for 2 years who presented to the emergency department with abdominal pain.
We diagnosed her with severe ketoacidosis with a normal glucose level (177 mg/dL) due to dapagliflozin, accompanying acute pancreatitis due to hypertriglyceridemia. We concluded that the precipitating factor for euglycemic ketoacidosis was pseudomembranous colitis.
She was treated with intravenous infusions of insulin, isotonic saline, and sodium bicarbonate as diabetic ketoacidosis treatment.
She was in shock with severe metabolic acidosis. After continuous renal replacement therapy, the uncontrolled metabolic ketoacidosis was treated, and she is currently under follow-up while receiving metformin (500 mg, once a day) and short- and long-acting insulins (8 units 3 times and 20 units once a day).
We report an unusual case of SGLT2 inhibitor-induced euglycemic ketoacidosis recovered by continuous renal replacement therapy in a patient with type 2 diabetes and recurrent acute pancreatitis due to hypertriglyceridemia. We diagnosed a rare complication of the SGLT2 inhibitor in a patient with type 2 diabetes in whom uncontrolled metabolic ketoacidosis could be effectively managed via continuous renal replacement therapy.
达格列净（一种钠-葡萄糖协同转运蛋白2[SGLT2]抑制剂）是最近被批准用于治疗2型糖尿病的口服药物类别。达格列净通过抑制近端肾小管对葡萄糖的重吸收来降低血浆葡萄糖浓度。2015年，美国食品药品监督管理局发布了一项关于服用此药物的患者发生酮症酸中毒风险可能增加的警告。
我们报告一例23岁2型糖尿病女性病例，她服用达格列净（10毫克，每日一次）治疗2年，因腹痛就诊于急诊科。
我们诊断她为达格列净所致的血糖正常的严重酮症酸中毒，伴有因高甘油三酯血症引起的急性胰腺炎。我们得出结论，正常血糖性酮症酸中毒的诱发因素是伪膜性结肠炎。
作为糖尿病酮症酸中毒的治疗，她接受了胰岛素、等渗盐水和碳酸氢钠的静脉输注治疗。
她处于休克状态，伴有严重代谢性酸中毒。经过持续肾脏替代治疗，失控的代谢性酮症酸中毒得到治疗，她目前正在接受随访，同时服用二甲双胍（500毫克，每日一次）以及短效和长效胰岛素（分别为8单位，每日3次和20单位，每日1次）。
我们报告了一例不寻常的病例，一名2型糖尿病且因高甘油三酯血症反复发生急性胰腺炎的患者，由SGLT2抑制剂引起的正常血糖性酮症酸中毒通过持续肾脏替代治疗得以康复。我们在一名2型糖尿病患者中诊断出SGLT2抑制剂的一种罕见并发症，该患者失控的代谢性酮症酸中毒可通过持续肾脏替代治疗得到有效控制。
