SGLT2-Inhibitor induced euglycemic ketoacidosis in acute surgical patients
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 45yearold female admitted for cholelithiasis and Aaron M. Hawkins1,2, Richard V. Jackson1,2, Hayden White2,3, Deepak L. Vardesh1,2 Affiliations: 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. Corresponding Author: Aaron Matthew Hawkins, 56 Cavan…
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