Literature analysis of euglycemic diabetic ketoacidosis induced by empagliflozin
- VernacularTitle:恩格列净致正常血糖性糖尿病酮症酸中毒的文献分析
- Author:
Zhenzhen LEI
1
;
Wei RUI
2
;
Yanling SHI
3
;
Jiayue ZHU
1
;
Ying GANG
1
;
Xiaodi SUN
1
;
Hao ZHAN
1
;
Junnan WANG
1
;
Yukun NIU
1
;
Wenxiang ZHANG
1
Author Information
1. Dept.of Pharmacy，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700，China
2. Dept.of Nursing，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700，China
3. Dept. of Pharmacy，Neiqiu County Hospital of Traditional Chinese Medicine，Hebei Xingtai 054200，China
- Publication Type:Journal Article
- Keywords:
empagliflozin;
sodium-glucose cotransporter 2 inhibitors;
euglycemic diabetic ketoacidosis;
adverse reaction;
case analysis
- From:
China Pharmacy
2026;37(14):1874-1879
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To investigate the clinical characteristics of euglycemic diabetic ketoacidosis （euDKA） induced by empagliflozin， and provide references for safe medication. METHODS Case reports of euDKA induced by empagliflozin were retrieved and analyzed from PubMed， Web of Science， CNKI， and Wanfang Data. The Naranjo’s scale was adopted to assess the causal relationship between empagliflozin and euDKA. RESULTS A total of 29 patients were enrolled， including 16 males and 13 females，with a median age of 58 years. All patients were diagnosed with type 2 diabetes mellitus； 22 patients had at least one comorbidity. The median time to euDKA onset was 60 days after administration， and 7 cases occurred within 2 weeks of treatment. Perioperative periods，fasting，and low-carbohydrate or ketogenic diets were the main predisposing factors. Common presentations included nausea，vomiting， fatigue， tachypnea，and tachycardia. The causal relationship between empagliflozin and euDKA was assessed as “probable” in all cases. According to adverse reaction severity grading， 13 cases were grade 3 （severe） and 16 cases were grade 4 （life-threatening）. All patients discontinued empagliflozin and recovered after corresponding treatment. CONCLUSIONS euDKA is a serious adverse reaction to empagliflozin， which mostly occurs early in treatment. Perioperative periods， fasting， and ketogenic diets are prone to induce euDKA. Elderly patients and those with comorbidities are at higher risk. Risk assessment should be conducted before clinical administration； blood ketones and acid-base monitoring should be strengthened in the early medication period； withhold the drug before elective surgery， avoid prolonged fasting；upon diagnosis， discontinue empagliflozin and initiate intravenous insulin， provide fluid resuscitation promptly， and use other treatments to improve patient prognosis.
