Nakagaito Masaki, Nakamura Makiko, Imamura Teruhiko, Ueno Hiroshi, Kinugawa Koichiro
Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
J Artif Organs. 2025 Mar;28(1):78-82. doi: 10.1007/s10047-024-01450-2. Epub 2024 May 26.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are strongly recommended in patients with heart failure, regardless of the presence of diabetes mellitus. A 74 year-old woman with a reduced left ventricular ejection fraction and diabetes mellitus (the types were unknown), receiving insulin and SGLT2 inhibitor, was hospitalized for altered consciousness with systemic hypotension. Upon admission, she was diagnosed with cardiogenic shock due to diabetic ketoacidosis. Intensive fluid resuscitation under Impella CP support successively improved her metabolic acidosis, preventing worsening pulmonary congestion by mechanically unloading the heart. After hemodynamic stabilization, she was diagnosed with type 1 diabetes mellitus for the first time. She was discharged on day 54 and was followed for 6 months without any recurrences. We must remain vigilant regarding the risk of diabetic ketoacidosis in patients using SGLT2 inhibitors, particularly those on insulin therapy or with diabetes mellitus of unknown types. Impella device shows promise as a circulatory support system in alleviating the left ventricle's workload and averting exacerbated pulmonary congestion, especially in cases where patients necessitate aggressive fluid replacement therapy, such as in the treatment of diabetic ketoacidosis concurrent with compromised cardiac function.
无论是否患有糖尿病，心力衰竭患者都强烈推荐使用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂。一名74岁女性，左心室射血分数降低且患有糖尿病（类型不明），正在接受胰岛素和SGLT2抑制剂治疗，因意识改变伴全身性低血压入院。入院时，她被诊断为糖尿病酮症酸中毒所致的心源性休克。在Impella CP支持下进行强化液体复苏，相继改善了她的代谢性酸中毒，通过机械性减轻心脏负荷防止了肺淤血加重。血流动力学稳定后，她首次被诊断为1型糖尿病。她于第54天出院，并随访6个月无复发。对于使用SGLT2抑制剂的患者，尤其是接受胰岛素治疗或患有不明类型糖尿病的患者，我们必须对糖尿病酮症酸中毒的风险保持警惕。Impella装置作为一种循环支持系统，在减轻左心室负荷和避免肺淤血加重方面显示出前景，特别是在患者需要积极补液治疗的情况下，如在治疗合并心功能不全的糖尿病酮症酸中毒时。
