Euglycemic Ketoacidosis in a Patient with Metastatic Non-Small-Cell Lung Adenocarcinoma and Concomitant Pulmonary Embolism

Abstract

Euglycemic ketoacidosis is a recognised side effect secondary to sodium-glucose cotransporter 2 inhibitor use in the treatment of type 2 diabetes mellitus; however, there is scarce evidence to suggest whether preexisting comorbid conditions contribute to the development of this potentially life-threatening complication. We describe a case of euglycemic ketoacidosis in a patient with type 2 diabetes mellitus in the context of empagliflozin use after a recent diagnosis of metastatic lung adenocarcinoma. The diagnosis was complicated by a pulmonary embolism and hospital-acquired pneumonia, and was subsequently established after an anion-gap metabolic acidosis was identified on arterial blood gas and serum ketone measurement. The patient required admission to the intensive care unit for fluid resuscitation and regular intravenous insulin to ensure resolution of acidosis and maintenance of normoglycaemia. The patient was discharged to home for outpatient single-agent pembrolizumab for treatment of his lung adenocarcinoma. This article highlights the importance or awareness of oral hypoglycaemic medications and their side effects, along with providing further evidence for the potential contribution of malignancy to the development of euglycemic ketoacidosis in a patient with type 2 diabetes mellitus.

The impact of the COVID-19 pandemic on diabetic ketoacidosis admissions to a COVID-19-free hospital

“…[19,20] While euglycemic DKA is an uncommon adverse event associated with SLGT2i, it is worth alerting oncologists about this relationship as more patients are using these drugs nowadays. [21,22] There was no difference regarding in-hospital mortality or need for mechanical ventilation between the two groups of patients. The cause of death was related to the underlying comorbidities in two T2DM patients and multiorgan failure in a young T1DM patient.…”

Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) Associated Diabetic Ketoacidosis in Oncology Patients: A Case Series and Literature Review

“…There are a few cases in the literature reporting SGLT2i-related DKA in oncology patients that are summarized in Table 2 [13][14][15][16][17]. This was observed with the use of dapagliflozin and empagliflozin as they are the widely used types of SGLT2i with additional approval use for heart failure and chronic kidney disease (CKD).…”

“…This was observed with the use of dapagliflozin and empagliflozin as they are the widely used types of SGLT2i with additional approval use for heart failure and chronic kidney disease (CKD). Two patients had adenocarcinoma of the pancreas [15,16], two patients with lung cancer [13,17], and one with colon cancer [14]. The majority of the reported cases developed DKA prior to the initiation of cancer-specific therapy.…”