El Ess Malak S, ElRishi Mohamed A
Department of Internal Medicine, AlAhli Hospital, Doha, Qatar.
Department of Endocrinology, AlAhli Hospital. Qatar University, Doha, Qatar.
Ann Med Surg (Lond). 2023 Apr 11;85(5):2097-2101. doi: 10.1097/MS9.0000000000000479. eCollection 2023 May.
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been implemented in treating diabetic patients for the past 10 years. Euglycemic diabetic ketoacidosis (euDKA) can be a life-threatening complication in diabetic patients. The authors report a severe euDKA with lactic acidosis in a type 2 diabetes mellitus (T2DM) patient. This report highlights the importance of the early detection and treatment of EuDKA to avoid complications.
Forty-four-year-old female with T2DM had multiple visits to the emergency department with recurrent diarrhoea and vomiting. On her third visit, she presented with shortness of breath and tachypnoea, found to have severe metabolic acidosis with euglycemia. She was admitted to ICU with euDKA secondary to SGLT2i and was managed accordingly.
The association between SGLT2i and euDKA in T2DM is controversial. SGLT2i leads to euDKA by stimulating lipolysis and ketogenesis in the setting of volume depletion, carbohydrate deficiency, and upregulation of counter-regulatory stress hormones. EuDKA can be life-threatening, especially if not diagnosed and managed properly. The treatment protocol is similar to hyperglycaemic diabetic ketoacidosis. Our case has been reported in line with the CARE criteria.34.
SGLT2i benefits in diabetic patients outweigh the risks. Clinicians are advised to counsel diabetic patients maintained on SGLT2 and educate them regarding holding the medication in the setting of acute illness, volume depletion, decreased oral intake, and surgery. In addition, there should be a high index of suspicion for patients presenting with metabolic acidosis in the background of SGLT2i use to provide early diagnosis and management.
在过去10年中，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）已被用于治疗糖尿病患者。正常血糖性糖尿病酮症酸中毒（euDKA）可能是糖尿病患者危及生命的并发症。作者报告了1例2型糖尿病（T2DM）患者发生的伴有乳酸性酸中毒的严重euDKA。本报告强调了早期发现和治疗euDKA以避免并发症的重要性。
一名44岁的T2DM女性因反复腹泻和呕吐多次前往急诊科就诊。在她第三次就诊时，出现呼吸急促和呼吸频率加快，检查发现存在伴有血糖正常的严重代谢性酸中毒。她因SGLT2i继发euDKA入住重症监护病房（ICU）并接受相应治疗。
SGLT2i与T2DM患者的euDKA之间的关联存在争议。SGLT2i通过在容量耗竭、碳水化合物缺乏和反调节应激激素上调的情况下刺激脂肪分解和酮体生成导致euDKA。euDKA可能危及生命，尤其是如果未得到正确诊断和处理。治疗方案与高血糖性糖尿病酮症酸中毒相似。我们的病例已按照CARE标准进行报告。
SGLT2i对糖尿病患者的益处大于风险。建议临床医生向使用SGLT2的糖尿病患者提供咨询，并就急性疾病、容量耗竭、口服摄入量减少和手术情况下停用药物对他们进行教育。此外，对于在使用SGLT2i背景下出现代谢性酸中毒的患者，应保持高度怀疑，以便早期诊断和处理。
