Diaz-Ramos Alexis, Eilbert Wesley, Marquez Diego
Department of Emergency Medicine, University of Illinois College of Medicine at Chicago, 1819 West Polk St. 469 COME, Chicago, IL, 60612, USA.
University of Illinois College of Medicine at Chicago, 1853 West Polk St. MC 785, Chicago, IL, 60612, USA.
Int J Emerg Med. 2019 Sep 5;12(1):27. doi: 10.1186/s12245-019-0240-0.
The sodium-glucose cotransporter-2 (SGLT2) inhibitors are the newest class of anti-hyperglycemic medications used in the treatment of diabetes mellitus. Their increasing use has been driven by their apparent cardiovascular and renal benefits. They have been associated with a small but significantly increased risk of diabetic ketoacidosis (DKA). Many of the cases of DKA associated with SGLT2 inhibitor use present with normal or minimally elevated serum glucose levels, often delaying the diagnosis.
A 44-year-old woman with diabetes mellitus presented to our emergency department complaining of 3 days of generalized weakness. The SGLT2 inhibitor canagliflozin had been added to her medication regimen 4 weeks earlier, and she had stopped using insulin 2 weeks prior to presentation. Laboratory evaluation revealed a metabolic acidosis with an elevated anion gap and the presence of serum acetone, despite a minimally elevated serum glucose of 163 mg/dL. The patient was treated for euglycemic DKA with intravenous infusions of insulin and dextrose, with resolution of her symptoms in 3 days.
The SGLT2 inhibitors are a novel class of anti-hyperglycemic medications that are being used with increasing frequency in the treatment of diabetes mellitus. They are associated with a small but significantly increased risk of DKA. Many of the patients presenting with DKA associated with SGLT2 inhibitor use will have normal or minimally elevated serum glucose levels. This unusual presentation of DKA can be diagnostically challenging.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是用于治疗糖尿病的最新一类抗高血糖药物。其使用频率不断增加，原因在于它们具有明显的心血管和肾脏益处。它们与糖尿病酮症酸中毒（DKA）风险小幅但显著增加有关。许多与SGLT2抑制剂使用相关的DKA病例表现为血糖水平正常或仅轻度升高，常常延误诊断。
一名44岁糖尿病女性因全身乏力3天就诊于我院急诊科。4周前其药物治疗方案中加用了SGLT2抑制剂卡格列净，就诊前2周她停用了胰岛素。实验室检查显示存在代谢性酸中毒，阴离子间隙升高且血清中有丙酮，尽管血清葡萄糖仅轻度升高至163mg/dL。该患者接受了正常血糖性DKA治疗，静脉输注胰岛素和葡萄糖，症状在3天内缓解。
SGLT2抑制剂是一类新型抗高血糖药物，在糖尿病治疗中的使用频率日益增加。它们与DKA风险小幅但显著增加有关。许多与SGLT2抑制剂使用相关的DKA患者血糖水平正常或仅轻度升高。这种DKA的不寻常表现可能在诊断上具有挑战性。
