Luo Xiaoqian, Ji Ran, Lu Weina, Zhu Hong, Li Libin, Hu Jun
Department of Surgical Intensive Care Unit, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Surg. 2022 Feb 23;9:769041. doi: 10.3389/fsurg.2022.769041. eCollection 2022.
Diabetic ketoacidosis (DKA), an acute and life-threatening complication of diabetes, is a metabolic disorder caused by insulin deficiency and an increase in counter-regulatory hormones. Several cases of DKA without marked hyperglycemia have been reported and are defined as euglycemic DKA (eu-DKA). The use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) is associated with the occurrence of eu-DKA, of which, dapagliflozin is one of the agents. In this study, we report a case of dapagliflozin-associated eu-DKA following surgery for pancreatic carcinoma. A 57-year-old woman presented with acute abdominal pain after surgery for pancreatic carcinoma. Emergency exploratory laparotomy was performed because of suspicion of gastrointestinal perforation based on a CT scan. The surgeons observed that the stomach was significantly dilated but not perforated. Meanwhile, the patient developed shock and severe acidosis. A further examination confirmed the diagnosis of dapagliflozin-associated eu-DKA. We reviewed the precipitating factors and mechanisms of SGLT2i-associated eu-DKA and discussed the treatment and prevention of this condition. Clinicians need to be alert of the occurrence of SGLT2i-associated eu-DKA in patients treated with this drug in the perioperative period.
糖尿病酮症酸中毒（DKA）是糖尿病一种急性且危及生命的并发症，是由胰岛素缺乏和升糖激素增加引起的代谢紊乱。已报告数例无明显高血糖的DKA病例，被定义为正常血糖性DKA（eu-DKA）。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的使用与eu-DKA的发生有关，其中达格列净是相关药物之一。在本研究中，我们报告了1例胰腺癌手术后发生的与达格列净相关的eu-DKA病例。一名57岁女性在胰腺癌手术后出现急性腹痛。基于CT扫描怀疑胃肠道穿孔而进行了急诊剖腹探查术。外科医生观察到胃明显扩张但未穿孔。与此同时，患者出现休克和严重酸中毒。进一步检查确诊为与达格列净相关的eu-DKA。我们回顾了SGLT2i相关eu-DKA的诱发因素和机制，并讨论了该病的治疗和预防。临床医生需要警惕围手术期使用该药物的患者发生SGLT2i相关eu-DKA。
