Gastric retention and ketoacidosis induced by combined use of semaglutide and empagliflozin
10.3760/cma.j.cn114015-20240318-00177
- VernacularTitle:司美格鲁肽联用恩格列净致胃潴留合并酮症酸中毒
- Author:
Yun LU
1
;
Fang CAO
1
;
Zhenghe TANG
1
Author Information
1. 济南市第八人民医院内分泌科，济南 271104
- Publication Type:Journal Article
- Keywords:
Glucagon-like peptide-1 receptor agonist;
Sodium-glucose transporters 2 inhibitor;
Gastric retention;
Diabetic ketoacidosis;
Semaglutide;
Empagliflozin
- From:
Adverse Drug Reactions Journal
2025;27(1):56-58
- CountryChina
- Language:Chinese
-
Abstract:
A 35-year-old male patient with type 2 diabetes mellitus was treated with metformin and dapagliflozin orally for a long time. Due to poor glycemic control and overweight, the treatment was adjusted to subcutaneous injection of semaglutide 0.25 mg once a week plus 1 metformin and empagliflozin tablet orally twice daily. The patient experienced abdominal bloating and significant satiety after the first dose, which did not attract attention, and metformin and empagliflozin tablets were not discontinued. Three days later, he developed persistent epigastric pain, and laboratory tests indicated blood ketone body (β-hydroxybutyrate) 4.70 mmol/L. Despite treatments with lansoprazole, anisodamine, metoclopramide, and dezocine, the symptoms was not alleviated. Gastrointestinal decompression was performed, which led to a slight improvement in abdominal pain. An immediate abdominal CT scan revealed gastric retention. The patient′s gastric retention was considered to be associated with the administration of semaglutide. The following day′s laboratory tests indicated carbon dioxide combining power 2.36 mmol/L, suggesting the occurrence of diabetic ketoacidosis, which was hypothesized to be related to empagliflozin. The original hypoglycemic regimen was discontinued, insulin pump therapy was given with blood glucose level monitoring, and fasting, gastrointestinal decompression, fluid resuscitation, and acid suppression was applied. The patient′s symptoms were significantly improved, and the ketone body levels gradually decreased. After 3 days of treatments, the patient began to eat, and after 6 days, he returned to a normal diet without further abdominal pain or bloating. The ketone body levels and carbon dioxide combining power returned to normal, and the hypoglycemic regimen was adjusted to lispro insulin plus acarbose.
