Chu Lulu, Xi Zhenhua, Ma Runzhi, Shi Weiliang, Yu Guoshen
Department of Neurology, Haiyan People's Hospital, Jiaxing City, 314300, Zhejiang Province, China.
BMC Neurol. 2025 Jan 14;25(1):20. doi: 10.1186/s12883-025-04027-5.
Sodium-glucose cotransporter-2(SGLT-2) inhibitors are a newer class of antidiabetic drugs with the increased risk of euglycemic diabetic ketoacidosis(EuDKA). Encephalopathy is a rare but life-threatening event of EuDKA. Due to paradoxically normal or slightly elevated serum glucose levels, it's easy to be mimicked by cerebral infarction, structural brain damage, thus leading to delayed diagnosis and causing seriously irreversible brain injury.
We report severe EuDKA with metabolic encephalopathy secondary to dapagliflozin in a type 2 diabetes mellitus(T2DM) patient.A 72-year-old female was found unconscious 70 minutes ago.Laboratory evaluation revealed a severe metabolic acidosis with an elevated anion gap, and ketones were elevated in the blood and positive in the urine. The patient was eventually diagnosed with metabolic encephalopathy associated with EuDKA and managed accordingly.
Metabolic encephalopathy is a rare but life-threatening complication of EuDKA caused by SGLT-2 inhibitors, the imaging features are similar to those of other metabolic encephalopathy such as poisoning and hypoxia. The precise pathogenesis of encephalopathy in EuDKA remains poorly understood, potentially resulting from the toxic consequences of electrolyte disturbances, ketosis, and acidosis.Testing the level of ketones is essential for unconscious patients who are taking SGLT-2 inhibitors.
钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂是一类新型抗糖尿病药物，会增加正常血糖性糖尿病酮症酸中毒（EuDKA）的风险。脑病是EuDKA一种罕见但危及生命的情况。由于血清葡萄糖水平反常地正常或略有升高，它很容易被脑梗死、结构性脑损伤所模拟，从而导致诊断延迟并造成严重的不可逆脑损伤。
我们报告了一例2型糖尿病（T2DM）患者因达格列净继发严重EuDKA并伴有代谢性脑病。一名72岁女性于70分钟前被发现昏迷。实验室检查显示严重代谢性酸中毒伴阴离子间隙升高，血液中酮体升高，尿液中酮体呈阳性。该患者最终被诊断为与EuDKA相关的代谢性脑病并进行了相应治疗。
代谢性脑病是由SGLT-2抑制剂引起的EuDKA一种罕见但危及生命的并发症，其影像学特征与中毒和缺氧等其他代谢性脑病相似。EuDKA中脑病的确切发病机制仍知之甚少，可能是由电解质紊乱、酮症和酸中毒的毒性后果所致。对于正在服用SGLT-2抑制剂的昏迷患者，检测酮体水平至关重要。
