Prolonged euglycemic diabetic ketoacidosis triggered by a single dose of sodium–glucose cotransporter 2 inhibitor

• Published in: BMJ case reports Vol. 13; no. 10; p. e235969
• Main Authors: Miwa, Maki, Nakajima, Mikio, Kaszynski, Richard H, Goto, Hideaki
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 07.10.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Acidosis; Acidosis - blood; Acidosis - etiology; Acidosis - therapy; Administration, Intravenous; Antibodies; Case reports; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetic ketoacidosis; Diabetic Ketoacidosis - blood; Diabetic Ketoacidosis - chemically induced; Diabetic Ketoacidosis - physiopathology; Diabetic Ketoacidosis - therapy; Drug dosages; Drug Monitoring; Duration of Therapy; Fatty acids; FDA approval; Female; Fluid Therapy - methods; Glucagon; Glucose; Glycemic Control - methods; Hemoglobin; Humans; Hypoglycemic Agents - administration & dosage; Insulin; Insulin - administration & dosage; Laboratories; Metabolism; Middle Aged; Patients; Proteins; Sodium-Glucose Transporter 2 Inhibitors - administration & dosage; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Treatment Outcome; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; Urine; primary care; diabetes; drugs: endocrine system
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-235969

A 45-year-old woman was admitted for diabetic ketoacidosis (DKA). Aggressive rehydration and continuous intravenous insulin resulted in improved blood glucose levels; however, metabolic acidosis persisted. One day prior to admission, the patient took a single dose of a sodium–glucose cotransporter 2 (SGLT2) inhibitor and this likely contributed to the prolonged euglycemic DKA. A single dose of this drug remained effective for over 100 hours as evidenced by massive excretion of urine glucose continuing long after blood glucose normalisation. SGLT2 inhibitor use should be refrained in cases in which DKA has already occurred as they may result in increasing severity or prolonged DKA.