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[Euglycemic ketoacidosis - rare condition on the rise]

Daniela Kampmeyer1, Friedhelm Sayk1

  • 1Medizinische Klinik 1, UKSH, Campus Lübeck.

Deutsche Medizinische Wochenschrift (1946)
|September 23, 2021
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors can cause euglycemic ketoacidosis (eKA), a dangerous condition mimicking diabetic ketoacidosis. Early diagnosis and treatment are crucial for managing this rare but serious side effect.

Area of Science:

  • Pharmacology
  • Endocrinology
  • Cardiology

Background:

  • SGLT2 inhibitors are antidiabetic drugs with proven cardiovascular and renal benefits, even in non-diabetic patients.
  • These drugs induce ketogenesis, similar to fasting states.
  • This mechanism can lead to life-threatening euglycemic ketoacidosis (eKA) under certain conditions.

Purpose of the Study:

  • To highlight the risk of euglycemic ketoacidosis (eKA) associated with SGLT2 inhibitors.
  • To discuss the diagnostic challenges and management strategies for SGLT2 inhibitor-induced eKA.
  • To emphasize the importance of prompt diagnosis and therapy in emergency settings.

Main Methods:

  • Review of randomized prospective studies on SGLT2 inhibitors.
  • Analysis of case reports and clinical data on euglycemic ketoacidosis.
  • Discussion of pathophysiological mechanisms and diagnostic criteria.

Main Results:

  • SGLT2 inhibitors can cause euglycemic ketoacidosis (eKA) at a rate of approximately 2:1000 patient-years.
  • Diagnosis is challenging due to normal blood glucose levels and potentially misleading ketone and glucose tests.
  • Management requires careful attention to blood glucose targets, hydration, and potassium levels.

Conclusions:

  • SGLT2 inhibitors, while beneficial, carry a risk of inducing euglycemic ketoacidosis (eKA).
  • Physicians must be aware of the diagnostic difficulties and specific management needs for eKA.
  • Prompt recognition and treatment are vital, especially with increasing SGLT2 inhibitor prescriptions.

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