Case Report
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Empagliflozine Bağlı Gelişen Öglisemik Diyabetik Ketoasidoz; Olgu Sunumu

Year 2021, Volume 4, Issue 3, 87 - 89, 30.10.2021

Abstract

Hiperglisemi (Kan şekeri> 250 mg/dL), metabolik asidoz (pH < 7,3), ketozis diyabetik ketoasidozun tanı kriterleri olarak belirtilmektedir. Nadiren kan şekeri 250 mg/dL altında diyabetik ketoasidoz görülebilmektedir. Bu durum öglisemik diyabetik ketoasidoz olarak adlandırılmaktadır. Nadir bir durum olmasına rağmen normal bir glukoz düzeyi tanıdan uzaklaştırabileceği için tedavinin gecikmesine ve bunun sonucunda artmış morbidite ve mortaliteye sebep olabilir. Sodyum-glukoz ko-transporter 2 (SGLT-2) inhibitörleri, diyabetes mellitus tedavisinde kullanılan yeni kuşak oral antidiyabetik ilaçlardır. Öglisemik diyabetik ketoasidoz gibi, nadir fakat ciddi advers etkileri vardır. Bu olgu sunumunda, nadir görülen bir durum olan empagliflozin kullanımına bağlı gelişen öglisemik diyabetik ketoasidoz olgusunun sunulması amaçlanmıştır.

References

  • 1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Res Clin Pract. 2019. 157;107843.
  • 2. Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism. 2016. 65(4);507-21. doi: 10.1016/j.metabol.2015.12.007. Epub 2015 Dec 19. PMID: 26975543
  • 3. Munro JF, Campbell IW, MacCuish AC, Duncan LC. Euglycaemic diabetic ketoacidosis. Br Med J 1973. 2(5866); 578–80.
  • 4. Verma S, McMurray JJV. SGLT2 inhibitors and mechanisms of cardiovascular benefit: a state-of-the-art review. Diabetologia. 2018. 61(10):2108-2117.
  • 5. Ray GM, Rodriguez C, Schulman SM, Sarangarm P, Bardack M, Bouchonville MF. (2019). Empagliflozin-induced Diabetic Ketoacidosis Unmasking a Type 1 Diabetes Diagnosis. Clin Pract Cases Emerg Med 2019. 3(2); 140.
  • 6. Rawla P, Vellipuram AR, Bandaru SS, Pradeep R. J. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinol Diabetes Metab Case Rep 2017. 2017. pii: 17-0081. doi: 10.1530. EDM-17-0081.
  • 7. Lucero P, Chapela S. Euglycemic Diabetic Ketoacidosis in the ICU: 3 Case Reports and Review of Literature. Case Rep Crit Care. 2018. 1;2018:1747850.
  • 8. Danne T, Garg S, Peters AL, Buse JB, Mathieu C, Pettus JH et al. International consensus on risk management of diabetic ketoacidosis in patients with type 1 diabetes treated with sodium–glucose cotransporter (SGLT) inhibitors. Diabetes Care 2019. 42(6);1147-54.
  • 9. Tahrani A A, Bailey C J, Del Prato S, Barnett AH. Management of type 2 diabetes: new and future developments in treatment. The Lancet 2011. 378(9786); 182-97.
  • 10. Drug Safety and Availability. FDA Drug Safety Communication: FDA revises labels of SGLT2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections. Available at: https://www.fda.gov/Drugs/DrugSafety/ ucm475463.htm. Accessed September 28, 2018.
  • 11. Lund S, Solimando F, Kohler S, Zeller C, Kaspers, S. Effect of empagliflozin on diabetic ketoacidosis in patients with type 2 diabetes: pooled clinical trial data. Diabetologie und Stoffwechsel 2017. 12(01); 209.
  • 12. Barski L, Eshkoli T, Brandstaetter E, Jotkowitz A. Euglycemic diabetic ketoacidosis. Eur J Intern Med. 2019 May;63:9-14.
  • 13. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S et al. EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015; 26;373(22):2117-28.
  • 14. Moioli A, Maresca B, Manzione A, Napoletano AM, Coclite D, Pirozzi N et al. Metformin associated lactic acidosis (MALA): clinical profiling and management. J Nephrol. 2016 Dec;29(6):783-9.

Euglycemic diabetic ketoacidosis due to empagliflozin; A Case Report

Year 2021, Volume 4, Issue 3, 87 - 89, 30.10.2021

Abstract

Hyperglycemia (Blood glucose> 250 mg / dL), metabolic acidosis (pH <7.3), ketosis are specified as diagnostic criteria for diabetic ketoacidosis. Rarely, diabetic ketoacidosis can be seen with blood glucose below 250 mg / dL. This condition is called euglycemic diabetic ketoacidosis. Although it is a rare condition, a normal glucose level may lead to delay in treatment and consequently increased morbidity and mortality, as it may distract from the diagnosis. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are new generation oral antidiabetic drugs used in the treatment of diabetes mellitus. There are rare but serious adverse drug effects, including euglycemic diabetic ketoacidosis In this case report, we aimed to present a case of euglycemic diabetic ketoacidosis due to empagliflozin use, which is a rare condition.

References

  • 1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Res Clin Pract. 2019. 157;107843.
  • 2. Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism. 2016. 65(4);507-21. doi: 10.1016/j.metabol.2015.12.007. Epub 2015 Dec 19. PMID: 26975543
  • 3. Munro JF, Campbell IW, MacCuish AC, Duncan LC. Euglycaemic diabetic ketoacidosis. Br Med J 1973. 2(5866); 578–80.
  • 4. Verma S, McMurray JJV. SGLT2 inhibitors and mechanisms of cardiovascular benefit: a state-of-the-art review. Diabetologia. 2018. 61(10):2108-2117.
  • 5. Ray GM, Rodriguez C, Schulman SM, Sarangarm P, Bardack M, Bouchonville MF. (2019). Empagliflozin-induced Diabetic Ketoacidosis Unmasking a Type 1 Diabetes Diagnosis. Clin Pract Cases Emerg Med 2019. 3(2); 140.
  • 6. Rawla P, Vellipuram AR, Bandaru SS, Pradeep R. J. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinol Diabetes Metab Case Rep 2017. 2017. pii: 17-0081. doi: 10.1530. EDM-17-0081.
  • 7. Lucero P, Chapela S. Euglycemic Diabetic Ketoacidosis in the ICU: 3 Case Reports and Review of Literature. Case Rep Crit Care. 2018. 1;2018:1747850.
  • 8. Danne T, Garg S, Peters AL, Buse JB, Mathieu C, Pettus JH et al. International consensus on risk management of diabetic ketoacidosis in patients with type 1 diabetes treated with sodium–glucose cotransporter (SGLT) inhibitors. Diabetes Care 2019. 42(6);1147-54.
  • 9. Tahrani A A, Bailey C J, Del Prato S, Barnett AH. Management of type 2 diabetes: new and future developments in treatment. The Lancet 2011. 378(9786); 182-97.
  • 10. Drug Safety and Availability. FDA Drug Safety Communication: FDA revises labels of SGLT2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections. Available at: https://www.fda.gov/Drugs/DrugSafety/ ucm475463.htm. Accessed September 28, 2018.
  • 11. Lund S, Solimando F, Kohler S, Zeller C, Kaspers, S. Effect of empagliflozin on diabetic ketoacidosis in patients with type 2 diabetes: pooled clinical trial data. Diabetologie und Stoffwechsel 2017. 12(01); 209.
  • 12. Barski L, Eshkoli T, Brandstaetter E, Jotkowitz A. Euglycemic diabetic ketoacidosis. Eur J Intern Med. 2019 May;63:9-14.
  • 13. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S et al. EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015; 26;373(22):2117-28.
  • 14. Moioli A, Maresca B, Manzione A, Napoletano AM, Coclite D, Pirozzi N et al. Metformin associated lactic acidosis (MALA): clinical profiling and management. J Nephrol. 2016 Dec;29(6):783-9.

Details

Primary Language Turkish
Subjects Medicine, Critical Care Medicine
Journal Section Olgu Sunumu
Authors

Pınar KARABACAK> (Primary Author)
SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-6210-5962
Türkiye


Süleyman ÇELİK This is me
SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-1244-5627
Türkiye


Ayşe KÖSEM This is me
SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0003-0377-5007
Türkiye


Mustafa Soner ÖZCAN>
SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0003-0385-2308
Türkiye


Eyyüp Sabri ÖZDEN>
SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-8070-0159
Türkiye

Publication Date October 30, 2021
Application Date April 21, 2021
Acceptance Date October 24, 2021
Published in Issue Year 2021, Volume 4, Issue 3

Cite

AMA Karabacak P. , Çelik S. , Kösem A. , Özcan M. S. , Özden E. S. Empagliflozine Bağlı Gelişen Öglisemik Diyabetik Ketoasidoz; Olgu Sunumu. Acta Med Nicomedia. 2021; 4(3): 87-89.

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