Suppr超能文献

一例28岁经皮冠状动脉介入治疗(PCI)后因钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂诱发正常血糖性糖尿病酮症酸中毒而长期恢复的病例

A Case of Prolonged Recovery for Post-percutaneous Coronary Intervention (PCI) Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor-Induced Euglycemic Diabetic Ketoacidosis in a 28-Year-Old.

作者信息

Petersen Cyrena, Gyabaah Frederick, Sotelo Jose, Yohanna Sandeesh, Deoker Abhizith

机构信息

Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, USA.

Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA.

出版信息

Cureus. 2023 Sep 13;15(9):e45180. doi: 10.7759/cureus.45180. eCollection 2023 Sep.

Abstract

Euglycemic diabetic ketoacidosis (DKA) is a rare, but clinically important, presentation that can lead to significant morbidity and mortality in patients with diabetes mellitus. It has been associated with multiple etiologies, including sodium-glucose cotransport-2 (SGLT2) inhibitor use. This case report details the presentation of a 28-year-old male patient who was recently diagnosed with non-ST elevated myocardial infarction (NSTEMI) status post-percutaneous coronary intervention (PCI) to left anterior descending (LAD) and type 2 diabetes mellitus (T2DM) and discharged on a new medical regiment that included an SGLT2 inhibitor. The patient presented five days later with dyspnea, nausea, and vomiting. On initial evaluation, he had tachycardia and hypertension. Lab work revealed hyperkalemia, metabolic anion gap acidosis, and the presence of ketones and glucose in the urine, which led to the diagnosis of euglycemic DKA. The patient was started on intravenous (IV) insulin, bicarbonate, and D5 ½ normal saline (NS) and required five days of continuous treatment for the anion gap to close. Considering studies have shown that SGLT2 inhibitors are associated with euglycemic DKA, it is proposed that the use of an SGLT2 inhibitor in this newly diagnosed, post-PCI patient led to the development of euglycemic DKA. DKA most commonly resolves within 24 hours of treatment; however, our patient did not recover until after 120 hours of treatment. Recent studies have suggested that SGLT2-inhibitor euglycemic DKA may be associated with longer recovery time; however, there is still a need to further research the consistency of these findings and quantify the estimated duration of treatment across populations. There is also a need for investigation into how co-morbid factors, such as a recent NSTEMI and PCI, may affect recovery times or predispose patients who are taking SGLT2-inhibitors to develop euglycemic DKA as SGLT2 inhibitors are being more widely prescribed. This case report highlights the importance of creating more detailed and evidence-based guidelines for prescribing SGLT2 inhibitors for patients with diabetes and encourages more research into the expected duration of treatment for patients with SGLT2-induced euglycemic DKA and factors that may affect it.

摘要

正常血糖性糖尿病酮症酸中毒(DKA)虽罕见,但具有临床重要性,可导致糖尿病患者出现严重发病和死亡情况。其病因多样,包括使用钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂。本病例报告详细介绍了一名28岁男性患者的情况,该患者近期被诊断为非ST段抬高型心肌梗死(NSTEMI),此前接受了左前降支(LAD)经皮冠状动脉介入治疗(PCI),同时患有2型糖尿病(T2DM),出院时开始使用包含SGLT2抑制剂的新药物治疗方案。五天后,患者出现呼吸困难、恶心和呕吐症状。初步评估时,他有心动过速和高血压。实验室检查显示高钾血症、代谢性阴离子间隙酸中毒,且尿液中存在酮体和葡萄糖,由此诊断为正常血糖性DKA。患者开始接受静脉注射胰岛素、碳酸氢盐和5%葡萄糖加0.45%生理盐水(D5 ½ NS)治疗,阴离子间隙闭合需要持续治疗五天。鉴于研究表明SGLT2抑制剂与正常血糖性DKA有关,推测在这位新诊断的PCI术后患者中使用SGLT2抑制剂导致了正常血糖性DKA的发生。DKA通常在治疗24小时内缓解;然而,我们的患者直到治疗120小时后才康复。近期研究表明,SGLT2抑制剂所致正常血糖性DKA可能与更长的恢复时间有关;然而,仍需进一步研究这些发现的一致性,并量化不同人群的估计治疗持续时间。还需要调查合并症因素,如近期的NSTEMI和PCI,如何影响恢复时间或使服用SGLT2抑制剂的患者易患正常血糖性DKA,因为SGLT2抑制剂的处方越来越广泛。本病例报告强调了为糖尿病患者制定更详细且基于证据的SGLT2抑制剂处方指南的重要性,并鼓励更多关于SGLT2诱导的正常血糖性DKA患者预期治疗持续时间及可能影响因素的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c9bf/10575758/898d38cf1ff3/cureus-0015-00000045180-i01.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验