A case of ketoacidosis due to type 2 diabetes treated with semaglutide combined with ertugliflozin
10.12173/j.issn.1005-0698.202412069
- VernacularTitle:司美格鲁肽联合艾托格列净治疗2型糖尿病致酮症酸中毒1例
- Author:
Min ZHANG
1
;
Yuan XU
1
;
Juan LI
1
Author Information
1. 成都市温江区人民医院药学部(成都 610000)
- Publication Type:Journal Article
- Keywords:
Semaglutide;
Ertugliflozin;
Diabetic ketoacidosis;
Adverse drug reactions
- From:
Chinese Journal of Pharmacoepidemiology
2025;34(3):346-352
- CountryChina
- Language:Chinese
-
Abstract:
This paper reports a case of a patient with type 2 diabetes mellitus(T2DM)who had poor blood-glucose control.Based on the previous oral administration of metformin,acarbose,and glimepiride,semaglutide and ertugliflozin were added.After the first injection of semaglutide,the patient presented with symptoms such as anorexia,nausea,and fatigue.After the second injection of semaglutide,the anorexia and fatigue worsened,and new symptoms including nausea,vomiting,acid reflux,abdominal distension,and muscle soreness emerged.Laboratory findings revealed severe acidosis(pH 6.698),markedly reduced serum bicarbonate(2.4 mmol·L-1),elevated blood glucose(15.54 mmol·L-1),significantly elevated blood ketones(HI),and urine ketones(+++),leading to a diagnosis of severe diabetic ketoacidosis(DKA).Considering the medical and medication history,it was considered that these were adverse reactions caused by semaglutide and ertugliflozin.After discontinuing these two drugs and providing insulin-based hypoglycemic treatment and symptomatic supportive treatment,the patient's condition improved.During the six-month follow-up period,no DKA-related symptoms reappeared.Using the Naranjo's Assessment Scale,the association was deemed"probable"for semaglutide and ertugliflozin-induced DKA.Severe anorexia caused by semaglutide likely led to insufficient carbohydrate intake,exacerbated by ertugliflozin's glucosuric effect,precipitating profound energy deficit and DKA.This case alerts medical staffto inform patients of the possible DKA risk when using semaglutide and ertugliflozin in combination for the treatment of T2DM.During the treatment,blood glucose,ketone bodies and other indicators should be regularly monitored.Once ketoacidosis is suspected,the drugs should be immediately discontinued and treatment should be initiated.
