Dhanasekaran Maheswaran, Narayanan Siddharth, Mastoris Ioannis, Mehta Suchita
Department of Endocrinology, Diabetes, Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
Endocrinol Diabetes Metab Case Rep. 2022 Mar 1;2022. doi: 10.1530/EDM-21-0035.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce osmotic diuresis by inhibiting the proximal renal tubular reabsorption of the filtered glucose load, which in turn can occasionally lead to severe dehydration and hypotension amidst other adverse effects. We present a case of a 49-year-old man with type 2 diabetes mellitus (T2D) on canagliflozin, a SGLT2i. The patient was brought to the emergency room following a motor vehicle accident. He was confused and had an altered mental status. His blood alcohol and urine toxicology screens were negative. Initial investigations revealed that he had severe hyponatremia with euglycemic ketoacidosis. The adverse condition was reversed with close monitoring and timely management, and the patient was eventually discharged. This is the first report to suggest hyponatremia as a potentially serious adverse effect following SGLT2i therapy. Its impact on the renal tubule handling of sodium and water is not yet well characterized. While further studies are warranted to understand better the pathophysiological mechanisms associated with SGLT2i-induced adverse effects, timely dose reduction or perhaps even its temporary discontinuation may be recommended to prevent complications.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are usually well-tolerated, but some serious adverse effects have been documented. Our case report suggests hyponatremia as a potential, rare side effect of SGLT2i and makes physicians aware of the occurrence of such life-threatening but preventable complications. Timely and close monitoring of the patient, with temporary discontinuation of this drug, may be recommended towards effective management. Studies demonstrating a comprehensive understanding of SGLT2i-related electrolyte derangements are warranted.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）通过抑制近端肾小管对滤过葡萄糖负荷的重吸收来诱导渗透性利尿，这反过来偶尔会导致严重脱水和低血压以及其他不良反应。我们报告一例49岁2型糖尿病（T2D）男性患者，正在使用SGLT2i卡格列净。该患者在机动车事故后被送往急诊室。他神志不清，精神状态改变。其血液酒精和尿液毒理学筛查均为阴性。初步检查发现他患有严重低钠血症伴正常血糖性酮症酸中毒。通过密切监测和及时处理，不良状况得以逆转，患者最终出院。这是首份提示低钠血症为SGLT2i治疗后潜在严重不良反应的报告。其对肾小管钠和水处理的影响尚未得到充分阐明。虽然有必要进行进一步研究以更好地理解与SGLT2i诱导的不良反应相关的病理生理机制，但可能建议及时减少剂量甚至暂时停药以预防并发症。
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）通常耐受性良好，但已记录到一些严重不良反应。我们的病例报告提示低钠血症是SGLT2i一种潜在的罕见副作用，并使医生意识到这种危及生命但可预防的并发症的发生。为有效管理，可能建议对患者进行及时密切监测，并暂时停用该药物。有必要开展研究以全面了解与SGLT2i相关的电解质紊乱。
