SGLT-2 inhibitor-associated significant hypernatremia and euglycemic diabetic ketoacidosis after cardiac surgery: a case series
Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) were initially developed for the treatment of type 2 diabetes mellitus. Subsequent studies demonstrated their beneficial effects in improving heart failure, leading to widespread clinical use. However, perioperative administration of SGLT-2i in cardiac surgery may result in severe hypernatremia, sometimes accompanied by euglycemic diabetic ketoacidosis (euDKA). Such occurrences have been rarely reported. Here, we present five cases.
Case presentation: In this retrospective single-center case series, we analyzed five patients who developed significant hypernatremia following coronary artery bypass grafting, two of whom were confirmed to have concomitant euDKA. We provide a detailed description of their clinical courses along with a review of relevant literature. All five patients had received SGLT-2 inhibitors during the perioperative period and subsequently developed marked hypernatremia, with or without euDKA. In one particularly challenging case, hypernatremia proved refractory to conventional management, ultimately necessitating continuous renal replacement therapy (CRRT).
Conclusions: SGLT-2 inhibitors induce hypernatremia and euDKA through multiple biological mechanisms, including osmotic diuresis. Because euDKA is characterized by ketoacidosis occurring in the absence of marked hyperglycemia, its diagnosis is often delayed or overlooked. Therefore, it is crucial to recognize the potential risk of these…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.