Euglycemic diabetic ketoacidosis caused by dapagliflozin in patient with diabetes mellitus during perioperative period of cardiac surgery
10.3760/cma.j.cn114015-20220503-00378
- VernacularTitle:达格列净致糖尿病心脏手术围手术期患者非高血糖性酮症酸中毒
- Author:
Haipeng YANG
1
;
Shuang CHEN
1
;
Weiwei ZHAO
1
;
Liling ZHAO
1
;
Ruohan XIE
1
;
Junxia LI
1
Author Information
1. 河南省胸科医院（郑州大学附属胸科医院）药学部，郑州 450100
- Publication Type:Journal Article
- Keywords:
Diabetes mellitus, type 2;
Perioperative period;
Sodium-glucose transporter 2 inhibitors;
Diabetic ketoacidosis;
Dapagliflozin
- From:
Adverse Drug Reactions Journal
2023;25(4):248-250
- CountryChina
- Language:Chinese
-
Abstract:
A 43-year-old male patient with type 2 diabetes mellitus underwent off-pump coronary artery bypass grafting due to coronary atherosclerotic heart disease. Dapagliflozin was stopped 24 hours before the operation, fasting and discontinuing oral medication started at 8: 00 pm 1 day before the operation. On the day of surgery, blood gas analysis and blood glucose were normal before undergoing cardiopulmonary bypass. Tracheal intubation was successfully removed 7 hours after operation. Blood glucose and anion gap were 11.2 mmol/L and 13 mmol/L, respectively on the 2nd day after operation. The treatments of hypoglycemic, antihypertensive and lipid-regulating drugs and normal diet were restored. On the morning of the 3rd day after operation, the patient developed symptoms such as shallow rapid breathing, poor appetite, excessive urine, and irritability. Blood gas analysis showed pH 7.05, arterial partial pressure of carbon dioxide (PaCO 2) 11 mmHg, base excess -24.5 mmol/L, actual bicarbonate 21.7 mmol/L; blood glucose 10.4 mmol/L, potassium 5.3 mmol/L, and routine urine test showed ketone body (+++) in urine. Treatments such as fluid replacement, electrolyte correction, and acid-base balance, and insulin therapy were given. Ten hours later, the blood gas analysis showed pH 7.44, PaCO 2 32 mmHg, alkali residual -2.5 mmol/L, actual bicarbonate 21.7 mmol/L, anion gap 12 mmol/L, blood glucose was 6.7 mmol/L, and routine urine test showed ketone body (++) in urine. The patient′s symptoms were gradually improved on the 4th day after the operation and then metformin, acarbose, and insulin injection were given for blood glucose management. It was considered that the patient had ketoacidosis, which might be associated with dapagliflozin. Then the hypoglycemic regimen was adjusted to oral metformin 0.85 g twice daily, acarbose 50 mg twice daily, and glimepiride 2 mg twice daily on the 15th day after operation. After that, the fasting blood glucose in the patient was maintained at 8.2-10.6 mmol/L, the postprandial blood glucose was maintained at 8.2-13.1 mmol/L, and the glycosylated hemoglobin was 7.3%. The patient′s ketoacidosis did not recur.
