Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY 10016, United States.
Vagelos College of Physicians and Surgeons-Columbia University, New York, NY 10032, United States.
Curr Diabetes Rev. 2021;17(2):243-246. doi: 10.2174/1573399816666200316112709.
Sodium-glucose cotransporter-2 [SGLT2] inhibitors reduce cardiovascular events and mortality in patients with diabetes, particularly patients with established cardiovascular disease. Euglycemic diabetic ketoacidosis [euDKA], a complication of SGLT2 therapy, can be exacerbated by a low carbohydrate diet.
A 61-year-old man with a history of type 2 diabetes, taking an SGLT2 inhibitor empagliflozin 10 mg orally daily, presented to the emergency room with a 2-day history of nausea and chest pain. A week prior to presentation, he had started a ketogenic diet. He was initially admitted with a diagnosis of acute coronary syndrome. On initial assessment in the emergency room, his cardiac enzymes were normal and there were no ischemic changes in his ECG. As there was concern for unstable angina, he underwent cardiac catheterization, which showed a known total occlusion with collaterals and arteries with a non-obstructive disease without any evidence of acute plaque rupture. His baseline laboratory assessments revealed an elevated anion gap of 17, increased urinary and plasma ketones, and metabolic acidosis. His plasma glucose level was 84 mg/dL. The diagnosis of euDKA was made, and treatment with intravenous fluids and insulin was initiated. His chest pain and nausea subsequently resolved.
We present a case of euDKA triggered by a ketogenic diet while on SGLT2 inhibitor therapy presenting as chest pain. The recognition of euDKA is important in the context of increased SGLT2 use for the management of cardiovascular risk for patients with diabetes.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂可降低糖尿病患者（尤其是已患有心血管疾病的患者）的心血管事件和死亡率。SGLT2 治疗的并发症——血糖正常的糖尿病酮症酸中毒（euDKA），可能因低碳水化合物饮食而加重。
一名 61 岁男性，患有 2 型糖尿病，每日口服 SGLT2 抑制剂恩格列净 10mg，因恶心和胸痛 2 天就诊于急诊室。在就诊前一周，他开始接受生酮饮食。他最初被诊断为急性冠状动脉综合征入院。在急诊室初步评估时，他的心肌酶正常，心电图无缺血改变。由于担心不稳定型心绞痛，他接受了冠状动脉造影检查，显示已知的总闭塞伴侧支循环和非阻塞性疾病的动脉，没有急性斑块破裂的任何证据。他的基线实验室检查显示阴离子间隙升高 17、尿和血浆酮体增加以及代谢性酸中毒。他的血浆葡萄糖水平为 84mg/dL。诊断为 euDKA，开始静脉补液和胰岛素治疗。他的胸痛和恶心随后得到缓解。
我们报告了一例在 SGLT2 抑制剂治疗期间因生酮饮食而引发的 euDKA 病例，表现为胸痛。在糖尿病患者心血管风险管理中，随着 SGLT2 应用的增加，认识到 euDKA 非常重要。
