Prolonged Ketosis and Glycosuria Secondary to SGLT2 Inhibitor Therapy

Overview

Journal Clin Case Rep

Date 2021 Nov 17

PMID 34786197

Citations 3

Authors

David Bobrowski

Reha Kumar

Peter E Wu

Lauren Lapointe-Shaw

Affiliations

Soon will be listed here.

Abstract

Clinicians should be aware of the potential for the pharmacologic activity of SGLT2 inhibitors to persist long after the standard drug clearance period of five half-lives, the typical duration used to guide pre-operative medication recommendations.

Citing Articles

Euglycemic Ketoacidosis in a Patient without Diabetes Taking Sodium-Glucose Cotransporter 2 Inhibitors for Heart Failure.

Miyazaki M, Nakano M, Takahashi H, Isaka Y, Hiura Y Am J Case Rep. 2024; 25:e943945.

PMID: 38985686 PMC: 11318733. DOI: 10.12659/AJCR.943945.

ERRATUM.

Clin Case Rep. 2021; 9(11):e05137.

PMID: 34853690 PMC: 8617334. DOI: 10.1002/ccr3.5137.

Prolonged ketosis and glycosuria secondary to SGLT2 inhibitor therapy.

Bobrowski D, Kumar R, Wu P, Lapointe-Shaw L Clin Case Rep. 2021; 9(11):e05057.

PMID: 34786197 PMC: 8577244. DOI: 10.1002/ccr3.5057.

References

Jeon J, Kim S, Kim K, Song S, Yun J, Kim B . Clinical characteristics of diabetic ketoacidosis in users and non-users of SGLT2 inhibitors. Diabetes Metab. 2019; 45(5):453-457. DOI: 10.1016/j.diabet.2019.01.001. View

Yehya A, Sadhu A . Sodium-Glucose Cotransporter 2 Inhibitor-Associated Prolonged Euglycemic Diabetic Ketoacidosis in Type 2 Diabetes: A Case Report and Literature Review. Clin Diabetes. 2020; 38(1):112-116. PMC: 6969664. DOI: 10.2337/cd19-0035. View

Peters A, Buschur E, Buse J, Cohan P, Diner J, Hirsch I . Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium-Glucose Cotransporter 2 Inhibition. Diabetes Care. 2015; 38(9):1687-93. PMC: 4542270. DOI: 10.2337/dc15-0843. View

Adachi J, Inaba Y, Maki C . Euglycemic Diabetic Ketoacidosis with Persistent Diuresis Treated with Canagliflozin. Intern Med. 2017; 56(2):187-190. PMC: 5337465. DOI: 10.2169/internalmedicine.56.7501. View

Devineni D, Polidori D . Clinical Pharmacokinetic, Pharmacodynamic, and Drug-Drug Interaction Profile of Canagliflozin, a Sodium-Glucose Co-transporter 2 Inhibitor. Clin Pharmacokinet. 2015; 54(10):1027-41. DOI: 10.1007/s40262-015-0285-z. View

Maraka S, Kearns A, Kittah N, OKeeffe D . Recurrent euglycemic diabetic ketoacidosis after discontinuation of sodium-glucose cotransporter 2 inhibitor. Diabetes Res Clin Pract. 2016; 118:77-8. DOI: 10.1016/j.diabres.2016.06.004. View

Miwa M, Nakajima M, Kaszynski R, Goto H . Prolonged euglycemic diabetic ketoacidosis triggered by a single dose of sodium-glucose cotransporter 2 inhibitor. BMJ Case Rep. 2020; 13(10). PMC: 7542622. DOI: 10.1136/bcr-2020-235969. View

Rafey M, Butt A, Coffey B, Reddington L, Devitt A, Lappin D . Prolonged acidosis is a feature of SGLT2i-induced euglycaemic diabetic ketoacidosis. Endocrinol Diabetes Metab Case Rep. 2019; 2019. PMC: 6765316. DOI: 10.1530/EDM-19-0087. View

Mistry S, Eschler D . Euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors and a Ketogenic Diet: A Case Series and Review of Literature. AACE Clin Case Rep. 2021; 7(1):17-19. PMC: 7924151. DOI: 10.1016/j.aace.2020.11.009. View

10.

Ata F, Yousaf Z, Khan A, Razok A, Akram J, Ali E . SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort. Sci Rep. 2021; 11(1):10293. PMC: 8119406. DOI: 10.1038/s41598-021-89752-w. View

11.

Kohli J, Goldfarb S . Quiz: Metabolic Acidosis in a Patient With Type 2 Diabetes. Am J Kidney Dis. 2017; 69(6):A11-A13. DOI: 10.1053/j.ajkd.2017.02.369. View

12.

Liu J, Lee T, DeFronzo R . Why Do SGLT2 inhibitors inhibit only 30-50% of renal glucose reabsorption in humans?. Diabetes. 2012; 61(9):2199-204. PMC: 3425428. DOI: 10.2337/db12-0052. View

13.

Pujara S, Ioachimescu A . Prolonged Ketosis in a Patient With Euglycemic Diabetic Ketoacidosis Secondary to Dapagliflozin. J Investig Med High Impact Case Rep. 2017; 5(2):2324709617710040. PMC: 5446101. DOI: 10.1177/2324709617710040. View

14.

Rosenstock J, Ferrannini E . Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, and Preventable Safety Concern With SGLT2 Inhibitors. Diabetes Care. 2015; 38(9):1638-42. DOI: 10.2337/dc15-1380. View

15.

Bobrowski D, Kumar R, Wu P, Lapointe-Shaw L . Prolonged ketosis and glycosuria secondary to SGLT2 inhibitor therapy. Clin Case Rep. 2021; 9(11):e05057. PMC: 8577244. DOI: 10.1002/ccr3.5057. View

16.

Weinstein J, Anderson S . The aging kidney: physiological changes. Adv Chronic Kidney Dis. 2010; 17(4):302-7. PMC: 2901622. DOI: 10.1053/j.ackd.2010.05.002. View

17.

Kelmenson D, Burr K, Azhar Y, Reynolds P, Baker C, Rasouli N . Euglycemic Diabetic Ketoacidosis With Prolonged Glucosuria Associated With the Sodium-Glucose Cotransporter-2 Canagliflozin. J Investig Med High Impact Case Rep. 2017; 5(2):2324709617712736. PMC: 5468766. DOI: 10.1177/2324709617712736. View

18.

Sloan G, Kakoudaki T, Ranjan N . Prolonged diabetic ketoacidosis associated with canagliflozin. Endocrinol Diabetes Metab Case Rep. 2018; 2018. PMC: 5993060. DOI: 10.1530/EDM-17-0177. View

19.

Francke S, Mamidi R, Solanki B, Scheers E, Jadwin A, Favis R . In vitro metabolism of canagliflozin in human liver, kidney, intestine microsomes, and recombinant uridine diphosphate glucuronosyltransferases (UGT) and the effect of genetic variability of UGT enzymes on the pharmacokinetics of canagliflozin in.... J Clin Pharmacol. 2015; 55(9):1061-72. DOI: 10.1002/jcph.506. View

20.

. 15. Diabetes Care in the Hospital: . Diabetes Care. 2020; 44(Suppl 1):S211-S220. DOI: 10.2337/dc21-S015. View