Altowayan Waleed M
Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, 51452, Qassim, Saudi Arabia.
Ann Med Surg (Lond). 2022 Nov 12;84:104879. doi: 10.1016/j.amsu.2022.104879. eCollection 2022 Dec.
Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes. Its defining features are hyperglycemia and ketoacidosis. Euglycemic DKA (EDKA) affects patients whose serum glucose levels are within the normal range. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is one of the newly identified risks for this condition.
A 75-year-old woman with type 2 diabetes mellitus presented to our emergency department with decreased consciousness and decreased oral intake for two days. She had been diagnosed with a cerebrovascular accident for 12 days, and empagliflozin was added to her medications. Laboratory evaluation revealed metabolic acidosis, despite a minimally elevated serum glucose concentration. The patient was admitted to the intensive care unit with EDKA secondary to empagliflozin and treated with intravenous rehydration therapy and intravenous insulin infusion.
Empagliflozin (SGLT2 inhibitor) is a new anti-hyperglycemic medication that is associated with an increased risk of DKA. Several patients present with normal or minimally elevated serum glucose concentration, which frequently leads to a delay in diagnosis. EDKA should be considered when evaluating a patient with unexplained metabolic acidosis while taking an SGLT2 inhibitor, and SGLT2 inhibitors should be discontinued if acidosis is confirmed.
糖尿病酮症酸中毒（DKA）是糖尿病最严重的急性并发症之一。其典型特征为高血糖和酮症酸中毒。正常血糖性糖尿病酮症酸中毒（EDKA）影响血清葡萄糖水平在正常范围内的患者。使用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是该病症新发现的风险因素之一。
一名75岁2型糖尿病女性因意识减退和经口摄入量减少两天就诊于我院急诊科。她12天前被诊断为脑血管意外，其药物治疗中加用了恩格列净。实验室检查显示，尽管血清葡萄糖浓度仅轻度升高，但存在代谢性酸中毒。该患者因恩格列净继发EDKA入住重症监护病房，接受静脉补液治疗和静脉输注胰岛素。
恩格列净（SGLT2抑制剂）是一种新型降糖药物，与DKA风险增加相关。部分患者血清葡萄糖浓度正常或仅轻度升高，这常导致诊断延迟。在评估服用SGLT2抑制剂且伴有不明原因代谢性酸中毒的患者时应考虑EDKA，若确诊酸中毒则应停用SGLT2抑制剂。
