Sodium–glucose cotransporter 2 inhibitor-induced euglycemic diabetic ketoacidosis in a patient with coronavirus disease 2019: a case report

Yii, Edwin Sze Sian; Azli, Athirah Wan; Sitaram, Premela Naidu

doi:10.1186/s13256-021-03232-3

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…Initially, a total of 3370 studies were identified from the databases, and after removing duplicates ( n = 1823), eight studies met the inclusion criteria and were included in this review. These studies consisted of seven case reports and one case series that investigated the incidence of eu-DKA in COVID-19 patients receiving SGLT2 inhibitors[ 14 - 21 ]. The combined study population across these studies comprised 12 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The patients included in the studies were from various countries, including the United States ( n = 3)[ 14 , 18 , 19 ], United Kingdom ( n = 5)[ 15 ], Brazil ( n = 1)[ 16 ], Malaysia ( n = 1)[ 20 ], and Belgium ( n = 2)[ 17 , 21 ]. The reported cases of type 1 diabetes mellitus (T1DM) were observed in the studies conducted in the United Kingdom and Belgium[ 17 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports

Khedr,

Hennawi,

Khan

et al. 2023

World J Clin Cases

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Alzheimer’s disease (AD) is a progressive and neurodegenerative illness which results in alterations in cognitive development. It is characterized by loss/dysfunction of cholinergic neurons, and formation of amyloid plaques, and formation of neurofibrillary tangles, among other changes, due to hyperphosphorylation of tau-protein. Exposure to pesticides in humans occurs frequently due to contact with contaminated food, water, or particles. Organochlorines, organophosphates, carbamates, pyrethroids and neonicotinoids are associated with the most diagnosed incidents of severe cognitive impairment. The aim of this study was to determine the effects of these pesticides on the phosphorylation of tau protein, and its cognitive implications in the development of AD. It was found that exposure to pesticides increased the phosphorylation of tau protein at sites Ser198, Ser199, Ser202, Thr205, Ser396 and Ser404. Contact with these chemicals altered the enzymatic activities of cyclin-dependent kinase 5 and glycogen synthase kinase 3 beta, and protein phosphatase-2A. Moreover, it altered the expression of the microtubule associated protein tau gene, and changed levels of intracellular calcium. These changes affected tau protein phosphorylation and neuroinflammation, and also increased oxidative stress. In addition, the exposed subjects had poor level of performance in tests that involved evaluation of novelty, as test on verbal, non-verbal, spatial memory, attention, and problem-solving skills.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports

Khedr,

Hennawi,

Khan

et al. 2023

World J Clin Cases

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Empagliflozin/insulin/sodium bicarbonate

2022

Reactions Weekly

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Empagliflozin/insulin/sodium bicarbonate Euglycaemic diabetic ketoacidosis and lack of efficacy: case reportA 37-year-old man developed euglycaemic diabetic ketoacidosis during treatment with empagliflozin for type 2 diabetes mellitus. Additionally, he exhibited lack of efficacy during treatment with insulin and sodium bicarbonate for euglycaemic diabetic ketoacidosis [not all routes and dosages stated].The man, who had type 2 diabetes mellitus for 2 years, presented to hospital in January 2021 with lethargy and shortness of breath. He tested positive for COVID-19 infection upon admission. His initial serum glucose level and arterial blood gas (ABG) values were found to be within normal range. He required admission for observation in view of symptomatic COVID-19 infection and did not require steroid therapy. He claimed to be compliant to his medications, which included empagliflozin 25mg daily for type 2 diabetes mellitus. On the third day of admission, he became more lethargic and had persistent vomiting. He was diagnosed with euglycaemic diabetic ketoacidosis, as his ABG showed high anion gap metabolic acidosis, urine ketone 3.0 mmol/L and capillary blood glucose 11.9 mmol/L. Other laboratory investigations showed the following: blood urea 11.4 mmol/L, chloride 106 mmol/L, sodium 136 mmol/L, potassium 4.5 mmol/L and creatinine 105 mmol/L.Therefore, the man started receiving unspecified IV fluids and fixed-scale insulin infusion, with resolution of the euglycaemic diabetic ketoacidosis on the following day. Later, on the seventh day of admission, he developed sudden progressive dyspnoea and tachypnoea with RR 40 breaths per minute without desaturation, HR 110 beats per minute and stable BP. The ABG taken under room air showed severe high anion gap acidosis with pH 6.87, lactate 1.7 mmol/L, pO2 37mm Hg, pCO2 17mm Hg, HCO 3-3.1 mmol/L, capillary blood glucose 10.9 mmol/L and serum ketones 4.2 mmol/L. Treatment for diabetic ketoacidosis was restarted along with unspecified broad-spectrum antibiotics, and he was referred for ICU admission on 19 January 2021 in view of the possibility of worsening pneumonia. He started receiving high-flow mask oxygen therapy while awaiting ICU admission. However, as a chest radiograph did not reveal worsening COVID-19 pneumonia, steroid therapy was not commenced. In the ICU, he was put on high-flow nasal cannula oxygen therapy with fraction of inspired oxygen. Protocolised diabetic ketoacidosis treatment was continued with fixed-scale insulin at 0.1 unit/kg body weight, unspecified IV fluids and potassium correction with sodium bicarbonate infusion; however, no improvement was observed. Further, it was noted that he had continued receiving empagliflozin throughout his stay in the ward, and it was immediately withheld in the ICU. Severe euglycaemic diabetic ketoacidosis due to empagliflozin was diagnosed in view of high anion gap metabolic acidosis, which could not be explained by the small rise in lactate and ketonaemia alone [time to reaction onset not stated]. His urine output rema...

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