Diabetic ketoacidosis induced by combination use of dulaglutide and empagliflozin
10.3760/cma.j.cn114015-20210401-00399
- VernacularTitle:度拉糖肽和恩格列净联用致糖尿病酮症酸中毒
- Author:
Xue ZHAO
1
;
Fan LI
;
Yanli ZHANG
;
Xiao ZHANG
;
Junling CAO
Author Information
1. 北京中医药大学东方医院药学部，北京 100078
- Publication Type:Journal Article
- Keywords:
Sodium-glucose transporter 2 inhibitors;
Diabetic ketoacidosis;
Drug synergism;
Glucagon-like peptide 1;
Empagliflozin;
Dulaglutide
- From:
Adverse Drug Reactions Journal
2022;24(3):147-149
- CountryChina
- Language:Chinese
-
Abstract:
A 41-year-old female patient received long-term treatment with metformin, glimepiride, sitagliptin, and acarbose for type 2 diabetes mellitus. Due to elevated blood-glucose, the hypoglycemic regimen was adjusted to metformin, acarbose, and dulaglutide (1.5 mg, subcutaneously injected once a week). After each injection of dulaglutide, the patient had severe anorexia but no intervention was given because that the patient could tolerate. Empagliflozin 10 mg orally once daily were added 3 days after the first injection and then the dose was adjusted to 10 mg next day. The day after the fourth injection, the patient developed dizziness, nausea, vomiting, general fatigue, etc. Laboratory tests showed blood glucose 20 mmol/L, arterial blood pH 7.22, partial pressure of carbon dioxide 22.1 mmHg, bicarbonate concentration 8.8 mmol/L, standard bicarbonate 12 mmol/L, total carbon dioxide content 10 mmol/L, ketone body in urine (+++), and urine sugar (++++). Diabetic ketoacidosis was diagnosed. Considering that severe anorexia after the application of dulaglutide caused serious insufficient carbohydrate intake and then empagliflozin-induced diabetic ketoacidosis was stimulated, the 2 drugs were discontinued and symptomatic and supportive treatments were given. Five days later, laboratory tests showed post-lunch blood glucose 10.1 mmol/L, ketone body in urine (+), negative urine sugar, and urine pH 5.5. Empagliflozin 5 mg once daily was added and laboratory tests showed carbon dioxide binding capacity of the blood 23.2 mmol/L, urine ketones (+++), urine sugar (++++), and uric acidity 5.0 four days later. The patient insisted on leaving the hospital. After discharge, she was treated with recombinant insulin glargine, acarbose, and empagliflozin. At 1 month of follow-up, symptoms of diabetic ketoacidosis did not recur.
