Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis.
Case report
Empagliflozin
Euglycemic ketoacidosis
Hyperchloremic acidosis
SGLT2 inhibitor
Journal
BMC endocrine disorders
ISSN: 1472-6823
Titre abrégé: BMC Endocr Disord
Pays: England
ID NLM: 101088676
Informations de publication
Date de publication:
14 Apr 2023
14 Apr 2023
Historique:
received:
24
11
2022
accepted:
10
04
2023
medline:
18
4
2023
entrez:
14
4
2023
pubmed:
15
4
2023
Statut:
epublish
Résumé
Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitors is a rare, relatively new and potentially fatal clinical entity, characterized by metabolic acidosis with normal or only moderately elevated glycemia. The mechanisms are not fully understood but involve increased ketogenesis and complex renal metabolic dysfunction, resulting in both ketoacidosis and hyperchloremic acidosis. We report a rare case of fatal empagliflozin-associated acidosis with profound hyperchloremia and review its pathogenesis. A patient with type 2 diabetes mellitus treated with empagliflozin underwent an elective hip replacement surgery. Since day 4 after surgery, he felt generally unwell, leading to cardiac arrest on the day 5. Empagliflozin-associated euglycemic diabetic ketoacidosis with severe hyperchloremic acidosis was identified as the cause of the cardiac arrest. This unique case documents the possibility of severe SGLT2 inhibitor-associated mixed metabolic acidosis with a predominant hyperchloremic component. Awareness of this possibility and a high index of suspicion are crucial for correct and early diagnosis.
Sections du résumé
BACKGROUND
BACKGROUND
Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitors is a rare, relatively new and potentially fatal clinical entity, characterized by metabolic acidosis with normal or only moderately elevated glycemia. The mechanisms are not fully understood but involve increased ketogenesis and complex renal metabolic dysfunction, resulting in both ketoacidosis and hyperchloremic acidosis. We report a rare case of fatal empagliflozin-associated acidosis with profound hyperchloremia and review its pathogenesis.
CASE PRESENTATION
METHODS
A patient with type 2 diabetes mellitus treated with empagliflozin underwent an elective hip replacement surgery. Since day 4 after surgery, he felt generally unwell, leading to cardiac arrest on the day 5. Empagliflozin-associated euglycemic diabetic ketoacidosis with severe hyperchloremic acidosis was identified as the cause of the cardiac arrest.
CONCLUSIONS
CONCLUSIONS
This unique case documents the possibility of severe SGLT2 inhibitor-associated mixed metabolic acidosis with a predominant hyperchloremic component. Awareness of this possibility and a high index of suspicion are crucial for correct and early diagnosis.
Identifiants
pubmed: 37060078
doi: 10.1186/s12902-023-01339-w
pii: 10.1186/s12902-023-01339-w
pmc: PMC10103020
doi:
Substances chimiques
empagliflozin
HDC1R2M35U
Sodium-Glucose Transporter 2 Inhibitors
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
81Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s).
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