Euglycemic Diabetic Ketoacidosis with Persistent Diuresis Treated with Canagliflozin

Adachi, Junichiro; Inaba, Yuusuke; Maki, Chisato

doi:10.2169/internalmedicine.56.7501

Cited by 20 publications

(20 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…SGLT2i‐associated DKA is often deemed “euglycaemic,” but it should be noted that only approximately one third of patients were admitted with a glucose level of less than 200 mg/dL. Nonetheless, the average glucose levels reported in SGLT2i‐associated DKA were lower than those in the rare cases of DKA reported in T2D patients (613.8 ± 114.5 mg/dL), probably because drug‐induced glycosuria keeps glucose levels low.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sodium‐glucose co‐transporter‐2 inhibitors and diabetic ketoacidosis: An updated review of the literature

Bonora

Avogaro

Fadini

2017

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are increasingly used for the treatment of type 2 diabetes (T2D) and can improve glucose control also in type 1 diabetes (T1D). In May 2015, regulatory agencies issued a warning that SGLT2is may cause diabetic ketoacidosis (DKA). We report details on 2 new cases of SGLT2i-associated DKA and review the literature for similar cases within randomized controlled trials (RCTs), cohort studies and single reports. We searched the medical literature for reports of SGLT2i-associated DKA cases. A quantitative analysis of frequency and clinical characteristics is reported. The 2 narrative cases illustrate that SGLT2i-associated DKA can occur in patients with T1D incorrectly diagnosed as T2D, perhaps without the presence of obvious DKA precipitating factors. The incidence of SGLT2i-associated DKA was less than 1/1000 in randomized controlled trials and 1.6/1000 person-years in cohort studies. We retrieved detailed data on 105 SGLT2i-associated DKA case reports, wherein 35% showed glucose levels of less than 200 mg/dL and 22% were not associated with typical triggers. In case reports and in pharmacovigilance databases, duration of SGLT2i treatment before DKA onset was extremely variable. Fatal SGLT2i-associated DKA episodes were found only in pharmacovigilance databases and represented 1.6% of all reported cases. DKA is a rare adverse event during SGLT2i therapy. Predisposing and precipitating factors are still incompletely understood, although a minority of cases lacked typical DKA triggers. More narrative case series and cohort studies are needed to better understand the true risk and the spectrum of this adverse event.

show abstract

Section: Discussionmentioning

confidence: 99%

“…We retrieved a total of 105 episodes of DKA in patients receiving SGLT2i from May 2014 to April 2017 . Demographic characteristics, type of diabetes and type of SGLT2i are reported in Table .…”

Section: Review Of the Literaturementioning

confidence: 99%

Sodium‐glucose co‐transporter‐2 inhibitors and diabetic ketoacidosis: An updated review of the literature

Bonora

Avogaro

Fadini

2017

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…In a review of literature, 46 cases of diabetic ketoacidosis associated with the use of SGLT-2 were found and, in 70% of the cases, the ketoacidosis was euglycemic [ 23 ]. The main mechanism of action is the inhibition of glucose uptake in proximal tubules, increasing glycosuria [ 24 ]. In addition, SGLT-2 inhibitors significantly increase plasma glucagon levels through a decrease in paracrine inhibition of insulin and possibly due to the inhibition of glucose transport into pancreatic α cells by SGLT-2 [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, SGLT-2 inhibitors significantly increase plasma glucagon levels through a decrease in paracrine inhibition of insulin and possibly due to the inhibition of glucose transport into pancreatic α cells by SGLT-2 [ 22 ]. At the same time, they decrease 3-hydroxybutyrate and acetoacetate elimination at the kidney level [ 24 – 28 ]. Moreover, when blood glucose levels decrease, patients that are being treated with insulin decrease its administration.…”

Section: Discussionmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis in the ICU: 3 Case Reports and Review of Literature

Lucero

Chapela

2018

Case Reports in Critical Care

View full text Add to dashboard Cite

Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus, both type I and type II, as well as other types with diabetes such gestacional diabetes mellitus. It is characterized by blood glucose levels greater than 250 mg/dL and metabolic acidosis (pH < 7.3 and serum bicarbonate < 15 mEq/dL) with an increased anion gap and the presence of ketone bodies in the blood or urine. Within this pathology, there is a subgroup of pathologies which are characterized by being present with no signs of hyperglycemia, posing a diagnostic challenge due to the absence of the main sign of the pathology and the diversity of their pathophysiology. In this article, we will present 3 clinical cases with 3 different forms of clinical presentation: a case of DKA in pregnancy, a case of DKA associated with the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and a third case related to sepsis, together with a narrative review of the literature on the topic.

show abstract

“…According to this case report there is still ongoing polyuria even after the patient has had euglycemia. 6 In another previous study shown that, polyuria was continued even after 11 days of discontinuation of SGLT-2 inhibitors. 10 In our case on the 7 th day of treatment, the serum glucose measurement was 96 mg/dL, the-refore the urine measurement showed +++ glycosuria.…”

Section: Discussionmentioning

confidence: 94%

Persistent Diuresis Associated Dapagliflozin Treatment

Gülmez¹,

Gülmez²

2018

Turkiye Klinikleri J Case Rep

View full text Add to dashboard Cite

odium glucose cotransporter 2 (SGLT2) inhibitors are oral antidiabetic drugs that improve urinary excretion of glucose, in this way regulating glycemic control and promoting weight loss. 1 The mechanism of action of SGLT2 inhibitors is a blood sugar reduction independent of insulin. 2 Diabetic ketoacidosis (DKA) is most serious acute metabolic complication of diabetes. 3 The use of oral antidiabetic agents including SLGT-2 inhibitors in the treatment of diabetic ketoacidosis is rare. 4,5 In the literature, the case of euglycemic diabetic ketoacidosis associated with canagliflozine has been discussed. In this case; persistent diuresis is discussed after normoglisemia. 6 However, an article about dapagliflozin is not available in the literature. In this article we will present diabetic ketoacidosis developed during the use of dapagliflozin. Persistent diurezis was discussed after acidosis was treatment and normoglycemia was maintained. CASE REPORT 55 years old male patient who had diabetes mellitus and HbA1c 15 mg/dL was recommended intensive insulin therapy by his internal medician doctor. The patient refused to use this treatment. Another doctor prescribed vildagliptin-metformin and dapagliflozin treatment to the patient. The patient used only dapagliflozin from this treatment regimen. The patient was brought back by his relatives due to nausea and vomiting after 4 months of starting oral antidiabetic treatment. The patient had nausea, vomiting and abdominal pain. On the day of admission to the hospital, the change of consciousness developed. He did smoke but didn't use alcohol.

show abstract

Euglycemic Diabetic Ketoacidosis with Persistent Diuresis Treated with Canagliflozin

Cited by 20 publications

References 12 publications

Sodium‐glucose co‐transporter‐2 inhibitors and diabetic ketoacidosis: An updated review of the literature

Sodium‐glucose co‐transporter‐2 inhibitors and diabetic ketoacidosis: An updated review of the literature

Euglycemic Diabetic Ketoacidosis in the ICU: 3 Case Reports and Review of Literature

Persistent Diuresis Associated Dapagliflozin Treatment

Contact Info

Product

Resources

About