Shah Mehul, Pathrose Edwin, Bhagwat Nikhil M, Chandy David
Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.
Department of Endocrinology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India.
Indian J Crit Care Med. 2022 Jan;26(1):123-126. doi: 10.5005/jp-journals-10071-24076.
Diabetic ketoacidosis (DKA) is an acute and major complication of diabetes mellitus (DM), both type I and type II. Biochemically, DKA consists of a triad of blood sugar levels greater than 250 mg/dL, ketonemia of greater than 3 mmol/L and/or significant ketonuria, and a blood pH less than 7.3 with an increased anion gap. Currently, the sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are widely used in management of type II diabetes. There have been several reports of an association between euglycemic diabetic ketoacidosis (EuDKA) and SGLT-2i agents. We present three different patients who were on SGLT-2i therapy who developed recurrent EuDKA postprocedure or sepsis. We believe that prolonged treatment (5-6 days) with intravenous (IV) insulin with glucose until resolution of glycosuria can be considered as an inexpensive marker of resolution of EuDKA. Moreover, the recommended duration for discontinuation of these drugs prior to elective procedures should be longer than 3 days. Shah M, Pathrose E, Bhagwat NM, Chandy D. "The Bitter Truth of Sugar"-Euglycemic Diabetic Ketoacidosis due to Sodium-glucose Cotransporter-2 Inhibitors: A Case Series. Indian J Crit Care Med 2022;26(1):123-126.
糖尿病酮症酸中毒（DKA）是I型和II型糖尿病的一种急性主要并发症。从生化角度来看，DKA由血糖水平高于250mg/dL、血酮水平高于3mmol/L和/或显著酮尿症以及血pH值低于7.3且阴离子间隙增加这三联征组成。目前，钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）被广泛用于II型糖尿病的治疗。已有数篇报道称正常血糖性糖尿病酮症酸中毒（EuDKA）与SGLT-2i药物之间存在关联。我们介绍了3例接受SGLT-2i治疗的不同患者，他们在术后或发生脓毒症后出现了复发性EuDKA。我们认为，静脉注射胰岛素加葡萄糖进行延长治疗（5 - 6天）直至糖尿消失，可被视为EuDKA缓解的一个低成本指标。此外，在择期手术前停用这些药物的推荐时长应超过3天。沙阿·M、帕特罗斯·E、巴格瓦特·N·M、钱迪·D。“糖的惨痛真相”——钠-葡萄糖协同转运蛋白2抑制剂所致正常血糖性糖尿病酮症酸中毒：病例系列。《印度重症监护医学杂志》2022年；26(1):123 - 126。
