SGLT2 Inhibitors and Perioperative Euglycemic Diabetic Ketoacidosis
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of diabetes medications that act at the level of the kidney to increase renal glucose clearance. The resultant hypoglycemia suppresses insulin secretion and stimulates glucagon, lipolysis, and ketogenesis, which creates a state of starvation. Since SGLT2 inhibitors also decrease sodium reabsorption, patients are at risk for dehydration. An unusual side effect of this drug class is the development of euglycemic diabetic ketoacidosis (eDKA). A case report describes a patient taking Synjardy® (empagliflozin/metformin) who underwent laparoscopic cholecystectomy and developed perioperative eDKA. It is critical to maintain a high index of suspicion to recognize eDKA and institute immediate therapy tenants of intravenous fluid hydration, insulin infusion, and aggressive electrolyte repletion.
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