Dapagliflozin-associated euglycemic diabetic ketoacidosis in a patient with type 2 diabetes mellitus: A case report.

摘要: Rationale Rare cases of euglycemic diabetic ketoacidosis (eu-DKA) have been reported after the administration sodium-glucose cotransporter-2 (SGLT-2) inhibitors. No reports described eu-DKA complicated by hypernatremia due to SGLT-2 Patient concerns A 76-year-old woman with a 40-year history type 2 diabetes mellitus (DM), for which metformin (1000 mg/day) and dapagliflozin (10 were prescribed, presented malaise, fever, oliguria. On presentation, her white blood cell count (11,800/μL), serum creatinine (3.2 mg/dL), C-reactive protein (54 mg/L) abnormal. Bilateral pyeloureteritis diffuse paralytic ileus present. She received intravenous antibiotics total parenteral nutrition, was asked fast. Her renal function briefly improved. Oral hypoglycemic agents, dapagliflozin, along enteral feeding reinstituted on day 3 hospitalization. However, 6 hospitalization, patient developed an altered state consciousness including confusion, lethargy, stupor. Several laboratory abnormalities suggestive euglycemia noted. Diagnoses The diagnosed accompanied severe (corrected Na concentration, 163 mEq/L) hypokalemia following re-administration. Interventions treated indicated fluid therapy. Dapagliflozin use discontinued. Outcomes patient's mental status findings improved gradually, she discharged maintenance doses insulin 14 Lessons Acute illnesses such as urinary tract infection, dietary restrictions or fasting in patients DM can be considered potential predisposing factors inhibitor-associated eu-DKA. For setting acute morbidity, timely resumption inhibitor therapy should carefully determined. In addition, may electrolyte disturbances hypokalemia.