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Colegio de Medicina Interna de México.

2019, Number 6

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Med Int Mex 2019; 35 (6)

Euglycemic diabetic ketoacidosis secondary to the administration of SGLT2 inhibitor

Córdova-Pluma VH, Vega-López CA, Carrillo-Ramírez SC, Ochoa-Salmorán H, Martínez-Martínez I, Delgado-Ayala F, Ortega-Chavarría MJ

Language: Spanish
References: 15
Page: 958-963
PDF size: 320.45 Kb.


ABSTRACT

Background: Canagliflozin is an SGLT2 inhibitor, 90% responsible of the kidneys’ glucose reabsorption. The glucose reabsorption blockage causes it to be eliminated through urine; it is prescribed in type 2 diabetes; euglycemic ketoacidosis is defined as metabolic acidosis with high gap anion, ketonemia or ketonuria and glucose levels lower than 200 mg/dL.
Clinical case: A 40-year-old male case treated with canagliflozin, with hypodynamia, asthenia and intermittent generalized weakness; he was admitted with the following data: positive ketones in urine, GAS: pH 7.10, PaCO2 20, HCO3 6, Lac 1.4, EB -24, AG 22, glucose 171 mg/dL, creatinine 1.5 mg/dL, treated with water restitution using a 0.9% saline solution of 3 L for three hours, as well as the restitution of bicarbonate in an insulin intake of 920 mEq, at 0.05 UI/kg/hour, as well as a mix solution at 5%. After 24 hours of treatment the result was: pH 7.44, PaCO2 30, HCO3 17, SaO2 94%, EB -4, AG 9, negative ketones and blood glucose level of 132 mg/dL. It was started basal insulin and then patient was discharged.
Conclusion: Diabetic ketoacidosis is one of the classic complications in the patient with diabetes, associated with a hyperglycemic state and predominantly occurs in patients with type 1 diabetes, although it is also observed in patients with type 2 diabetes.


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