Somagutta Manoj R, Agadi Kuchalambal, Hange Namrata, Jain Molly S, Batti Erkan, Emuze Bernard O, Amos-Arowoshegbe Elizabeth O, Popescu Sorin, Hanan Saad, Kumar Varadha Retna, Pormento Kezia
Department of Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Department of Medicine, Avalon University School of Medicine, Willemstad, CUW.
Cureus. 2021 Mar 3;13(3):e13665. doi: 10.7759/cureus.13665.
Diabetic ketoacidosis (DKA) is an acute and significant life-threatening complication of diabetes. The association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) with euglycemic diabetic ketoacidosis (EDKA) has been well reported. This literature review was conducted to understand the mechanism of EDKA and identify the potential risk factors and precipitants for patients taking SGLT2i. After reviewing the published literature between 2010 and 2020, 32 articles are included in the final review. The underlying mechanism is mainly enhanced lipolysis and ketone body reabsorption. SGLT2i also stimulates pancreatic alpha cells and inhibits beta cells, causing an imbalance in glucagon/insulin levels, further contributing to lipolysis and ketogenesis. Most patients were diagnosed with blood glucose less than 200 mg/dL, blood pH <7.3, increased anion gap, increased blood, or urine ketones. Perioperative fasting, pancreatic etiology, low carbohydrate or ketogenic diet, obesity, and malignancy are identified precipitants in this review. As normoglycemia can conceal the underlying acidosis, physicians should be cognizant of the EDKA diagnosis and initiate prompt treatment. Patient education on risk factors and triggers is recommended to avoid future events.
糖尿病酮症酸中毒（DKA）是糖尿病一种严重的急性危及生命的并发症。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）与正常血糖性糖尿病酮症酸中毒（EDKA）之间的关联已有充分报道。进行本次文献综述旨在了解EDKA的机制，并确定服用SGLT2i患者的潜在风险因素和诱发因素。在回顾了2010年至2020年间发表的文献后，最终纳入综述的文章有32篇。其潜在机制主要是脂肪分解增强和酮体重吸收增加。SGLT2i还刺激胰腺α细胞并抑制β细胞，导致胰高血糖素/胰岛素水平失衡，进一步促进脂肪分解和酮生成。大多数患者诊断时血糖低于200mg/dL，血pH<7.3，阴离子间隙增加，血或尿酮体增加。围手术期禁食、胰腺病因、低碳水化合物或生酮饮食、肥胖和恶性肿瘤是本综述中确定的诱发因素。由于正常血糖可能掩盖潜在的酸中毒，医生应认识到EDKA的诊断并及时开始治疗。建议对患者进行危险因素和诱发因素的教育，以避免未来发生此类情况。
