Goto Shunsaku, Ishikawa Jun-Ya, Idei Masafumi, Iwabuchi Masahiro, Namekawa Motoki, Nomura Takeshi
Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Am J Case Rep. 2021 Mar 16;22:e929773. doi: 10.12659/AJCR.929773.
BACKGROUND Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are widely used owing to their effective glycemic control and protective effects against heart and kidney failure. Euglycemic diabetic ketoacidosis (eu-DKA) is a complication of treatment with SGLT2is. Eu-DKA often leads to delayed diagnosis and results in life-threatening complications. We report 2 critical cases of SGLT2i-associated eu-DKA. CASE REPORT Case 1 was 52-year-old woman with unstable angina scheduled for elective coronary artery bypass grafting surgery. Preoperatively, she underwent tooth extraction which led to poor food intake because of pain. Three days before surgery, the patient had SGLT2i-associated eu-DKA and myocardial infraction, requiring percutaneous coronary intervention and peripheral venoarterial extracorporeal membrane oxygenation. The patient had taken SGLT2i until the morning of admission to the intensive care unit. Case 2 was a 76-year-old woman experiencing SGLT2i-associated eu-DKA and sinus arrest, necessitating a temporary pacemaker, followed by elective gastrojejunal bypass surgery. The SGLT2i was discontinued the day before surgery. On day 3 following surgery, the patient's metabolic acidosis improved, and sinus arrest resolved. CONCLUSIONS Precipitating factors of eu-DKA (caloric restriction and surgical stress) and delay in diagnosis because of a lack of evidence of hyperglycemia could contribute to the development and worsening of life-threatening complications. This reiterates the importance of reviewing ongoing medications of patients with diabetes and considering eu-DKA as a differential diagnosis for patients with high anion gap metabolic acidosis to ensure early intervention. SGLT2i-associated DKA likely develops perioperatively; therefore, clinicians should pay attention to the discontinuation period of SGLT2i before any surgical intervention.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）因其有效的血糖控制及对心力衰竭和肾衰竭的保护作用而被广泛应用。正常血糖性糖尿病酮症酸中毒（eu-DKA）是SGLT2i治疗的一种并发症。eu-DKA常导致诊断延迟，并引发危及生命的并发症。我们报告2例SGLT2i相关eu-DKA的危急病例。病例报告：病例1为一名52岁患有不稳定型心绞痛的女性，计划行择期冠状动脉旁路移植术。术前，她接受了拔牙，因疼痛导致进食不佳。手术前3天，该患者发生了SGLT2i相关eu-DKA和心肌梗死，需要进行经皮冠状动脉介入治疗及外周静脉-动脉体外膜肺氧合。该患者在入住重症监护病房的当天早晨仍在服用SGLT2i。病例2为一名76岁女性，发生了SGLT2i相关eu-DKA和窦性停搏，需要植入临时起搏器，随后行择期胃空肠旁路手术。SGLT2i在手术前一天停用。术后第3天，患者的代谢性酸中毒改善，窦性停搏消失。结论：eu-DKA的诱发因素（热量限制和手术应激）以及因缺乏高血糖证据导致的诊断延迟可能促使危及生命的并发症发生和恶化。这再次强调了审查糖尿病患者正在服用的药物以及将eu-DKA作为高阴离子间隙代谢性酸中毒患者鉴别诊断的重要性，以确保早期干预。SGLT2i相关DKA可能在围手术期发生；因此，临床医生在任何手术干预前应注意SGLT2i的停用时间。
