Alhemeiri Mohamed, Alseddeeqi Eiman
Medical Education Department, Sheikh Khalifa Medical City, P.O. Box 51900, Abu Dhabi, UAE.
Division of Endocrinology, Sheikh Khalifa Medical City, P.O. Box51900, Abu Dhabi, UAE.
Case Rep Endocrinol. 2022 Mar 2;2022:4101975. doi: 10.1155/2022/4101975. eCollection 2022.
Sodium glucose cotransporter-2 (SGLT2) inhibitors have been proven to be very effective in the management of type II diabetes. These medications can cause adverse drug reactions such as genital mycotic infections. Another critical adverse drug reaction is euglycemic diabetic ketoacidosis (EDKA) under the setting of other contributing risk factors for developing diabetic ketoacidosis. . We report a case of a 45-year-old gentleman with type 2 diabetes mellitus on empagliflozin, metformin, and glimepiride who presented with abdominal pain, fatigue, and vomiting. Of note, he started a ketogenic diet three days before his presentation and self-stopped his antidiabetic medications two days before his presentation. The patient was found to have euglycemic diabetic ketoacidosis and was treated as per the protocol. He was discharged on metformin and pioglitazone. Two weeks following discharge, canagliflozin was added.
Euglycemic diabetic ketoacidosis could still be precipitated despite discontinuation of SGLT2I under a ketogenic diet. Discussion related to the initiation of a ketogenic diet should occur between the care provider and the patient.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已被证明在2型糖尿病的管理中非常有效。这些药物可引起不良药物反应，如生殖器霉菌感染。另一个关键的不良药物反应是在存在其他导致糖尿病酮症酸中毒的危险因素的情况下发生的正常血糖性糖尿病酮症酸中毒（EDKA）。我们报告一例45岁2型糖尿病男性患者，正在服用恩格列净、二甲双胍和格列美脲，出现腹痛、乏力和呕吐。值得注意的是，他在就诊前三天开始生酮饮食，并在就诊前两天自行停用了抗糖尿病药物。该患者被诊断为正常血糖性糖尿病酮症酸中毒，并按照方案进行治疗。他出院时服用二甲双胍和吡格列酮。出院两周后，加用了卡格列净。
尽管在生酮饮食下停用了SGLT2抑制剂，但仍可能诱发正常血糖性糖尿病酮症酸中毒。医疗服务提供者和患者之间应就生酮饮食的启动进行讨论。
