Journal of

Case Reports and Images in Surgery

 
     
Case Series
 
SGLT2-Inhibitor induced euglycemic ketoacidosis in acute surgical patients
Aaron M. Hawkins1,2, Richard V. Jackson1,2, Hayden White2,3, Deepak L. Vardesh1,2
1Department of Medicine, Logan Hospital, Meadowbrook, QLD, Australia
2School of Medicine, Griffith University, Gold Coast, QLD, Australia
3Department of Intensive Care, Logan Hospital, Meadowbrook, QLD, Australia

Article ID: 100046Z12AH2017
doi:10.5348/Z12-2017-46-CS-11

Address correspondence to:
Aaron Matthew Hawkins
56 Cavan Street Annerley
QLD
Australia 4103

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How to cite this article
Hawkins AM, Jackson RV, White H, Vardesh DL. SGLT2-Inhibitor induced euglycemic ketoacidosis in acute surgical patients. J Case Rep Images Surg 2017;3:41–46.


ABSTRACT

Introduction: A significant adverse effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors is euglycaemic ketoacidosis. This is of particular significance for surgeons as the combination of long periods of fasting, surgical stress and reduced insulin dosing in acute surgical patients leaves them at an increased risk for developing euglycemic ketoacidosis. This case series reports the adverse reaction to empagliflozin, canagliflozin and dapagliflozin in four acute surgical patients.
Case Series: Case 1: A 43-year-old female underwent elective total abdominal hysterectomy, bilateralsalpingectomy and incisional hernia repair, on a background of type 2 diabetes mellitus (T2DM) treated with metformin, insulin and empagliflozin. She developed significant euglycaemic ketoacidosis complicated by sepsis and a rectus abdominushaematoma. Case 2: A 70-year-old female with acute cholecystitis on a background of T2DM treated with metformin, insulin and canagliflozin. She developed euglycemic ketoacidosis after a 12-hour fast and 24-hour without her usual insulin. Case 3: A 45-year- old female admitted for cholelithiasis and subsequent cholecystectomy on a background of T2DM treated with metformin and dapagliflozin. She developed euglycemic ketoacidosis day-1 post procedure. Case 4: A 49-year-old female who presented with a right thigh abscess and fever, requiring incision and drainage, on a background of T2DM managed with metformin and dapagliflozin. She developed euglycemic ketoacidosis after an extended period of fasting.
Conclusion: Given the increasing use of SGLT2i and the unique combination of risk factors present for surgical patients, it is important that surgeons are familiar with this condition and able to diagnose and treat it early.

Keywords: SGLT2, Euglycemic Ketoacidosis, Type 2 diabetes mellitus (T2DM)


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Author Contributions
Aaron Matthew Hawkins – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Richard V Jackson – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hayden White – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Deepak L Vardesh – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Aaron Matthew Hawkins et al. This article is distributed of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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