Ketoacidosis with euglycemia in a patient with type 2 diabetes mellitus taking dapagliflozin: A case report. Issue 3 (January 2019)

• Record Type: Journal Article
• Authors: Yeo, Sang Mok; Park, Hayeon; Paek, Jin Hyuk; Park, Woo Yeong; Han, Seungyeup; Park, Sung Bae; Jin, Kyubok
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 98:Issue 3(2019)
• Publication Date: 2019-01
• Subjects: dapagliflozin -- ketoacidosis -- renal replacement therapy -- SGLT2 inhibitor; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000014150
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Dapagliflozin (a sodium-glucose cotransporter-2 [SGLT2] inhibitor) represents the most recently approved class of oral medications for the treatment of type 2 diabetes. Dapagliflozin lowers plasma glucose concentration by inhibiting the renal reuptake of glucose in the proximal renal tubules. In 2015, the US Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis in patients taking this medication. Patient concerns: We present the case of a 23-year-old woman with type 2 diabetes treated with dapagliflozin (10 mg, once a day) for 2 years who presented to the emergency department with abdominal pain. Diagnoses: We diagnosed her with severe ketoacidosis with a normal glucose level (177 mg/dL) due to dapagliflozin, accompanying acute pancreatitis due to hypertriglyceridemia. We concluded that the precipitating factor for euglycemic ketoacidosis was pseudomembranous colitis. Interventions: She was treated with intravenous infusions of insulin, isotonic saline, and sodium bicarbonate as diabetic ketoacidosis treatment. Outcomes: She was in shock with severe metabolic acidosis. After continuous renal replacement therapy, the uncontrolled metabolic ketoacidosis was treated, and she is currently under follow-up while receiving metformin (500 mg, once a day) and short- and long-acting insulins (8 units 3 times and 20 units once a day). Lessons: We report an unusual case of SGLT2 inhibitor-induced euglycemic ketoacidosis recovered by continuous renal replacement therapy in a patient with type 2 diabetes and recurrent acute pancreatitis due to hypertriglyceridemia. We diagnosed a rare complication of the SGLT2 inhibitor in a patient with type 2 diabetes in whom uncontrolled metabolic ketoacidosis could be effectively managed via continuous renal replacement therapy.