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Somagutta MR, Agadi K, Hange N, Jain MS, Batti E, Emuze BO, Amos-Arowoshegbe EO, Popescu S, Hanan S, Kumar VR, Pormento K. Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers. Cureus 2021; 13:e13665. [PMID: 33824816 PMCID: PMC8012260 DOI: 10.7759/cureus.13665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is an acute and significant life-threatening complication of diabetes. The association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) with euglycemic diabetic ketoacidosis (EDKA) has been well reported. This literature review was conducted to understand the mechanism of EDKA and identify the potential risk factors and precipitants for patients taking SGLT2i. After reviewing the published literature between 2010 and 2020, 32 articles are included in the final review. The underlying mechanism is mainly enhanced lipolysis and ketone body reabsorption. SGLT2i also stimulates pancreatic alpha cells and inhibits beta cells, causing an imbalance in glucagon/insulin levels, further contributing to lipolysis and ketogenesis. Most patients were diagnosed with blood glucose less than 200 mg/dL, blood pH <7.3, increased anion gap, increased blood, or urine ketones. Perioperative fasting, pancreatic etiology, low carbohydrate or ketogenic diet, obesity, and malignancy are identified precipitants in this review. As normoglycemia can conceal the underlying acidosis, physicians should be cognizant of the EDKA diagnosis and initiate prompt treatment. Patient education on risk factors and triggers is recommended to avoid future events.
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Affiliation(s)
- Manoj R Somagutta
- Department of Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Medicine, Avalon University School of Medicine, Willemstad, CUW
| | | | - Namrata Hange
- Public Health, Woodlands Health Campus, Singapore, SGP
| | - Molly S Jain
- Department of Medicine, Saint James School of Medicine, Park Ridge, USA
| | - Erkan Batti
- Department of Medicine, Washington University Health and Science, San Pedro, BLZ
| | - Bernard O Emuze
- Emergency Medicine, Saint James School of Medicine, Fort Worth, USA
| | | | - Sorin Popescu
- Department of Medicine, Saint James School of Medicine, Park Ridge, USA
| | - Saad Hanan
- Department of Medicine, Saint James School of Medicine, Park Ridge, USA
| | | | - Kezia Pormento
- Department of Medicine, Ateneo de Manila School of Medicine and Public Health, Quezon City, PHL
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