Peri‐procedural ketoacidosis risk with sodium‐glucose cotransporter 2 inhibitor use in people without diabetes
Abstract
We wish to inform readers of the potential peri-procedural risk of ketoacidosis in association with sodium-glucose cotransporter 2 inhibitors (SGLT2i) use in patients without diabetes. These are increasingly prescribed for patients with heart failure and chronic kidney disease, irrespective of their diabetic status. Until now, the risk of ketoacidosis with SGLT2i use has been reportedly limited to individuals with type-2 diabetes. However, the Australian Product Information for empagliflozin has recently changed and now states “cases of ketoacidosis have also been reported in patients without diabetes” [1]. Amongst the heart failure and renal SGLT2i outcome studies, there was one case of ketoacidosis in a patient without diabetes randomised to empagliflozin treatment in the EMPA-KIDNEY study [2]. There has been one published case report of ketoacidosis in a normoglycaemic patient taking an SGLT2i for heart failure [3]. The casewas an 83-year-old female who had fasted from midnight for a scheduled transcatheter aortic valve replacement which took place in the early afternoon. She had taken dapagliflozin that morning. She had stage-2 chronic kidney disease and experienced diarrhoea 6 days before the procedure. Of note, she was hypoglycaemic immediately post-procedure and the following morning when ketoacidosis was diagnosed. There are multiple potential mechanisms for periprocedural ketoacidosis in the population of patients
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