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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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[Perioperative Ketoacidosis under SGLT2-Inhibitors].

Sandra Buck, Sebastian G Russo

    Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
    |October 27, 2021
    PubMed
    Summary

    Sodium-glucose cotransporter-2-inhibitors (SGLT2 inhibitors) can cause rare but severe euglycemic ketoacidosis. Anesthesiologists must recognize this risk, especially during perioperative catabolic states, to ensure timely diagnosis and treatment.

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    Area of Science:

    • Endocrinology
    • Pharmacology
    • Anesthesiology

    Background:

    • Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are increasingly used for type 2 diabetes mellitus.
    • These agents carry a risk of rare but serious adverse events, including euglycemic ketoacidosis.

    Observation:

    • A case report details a patient experiencing severe euglycemic ketoacidosis during the perioperative period while on SGLT2 inhibitor therapy.
    • The patient presented with nonspecific symptoms, highlighting the diagnostic challenge.

    Findings:

    • Typical laboratory findings indicative of severe euglycemic ketoacidosis were observed.
    • The case underscores the importance of recognizing SGLT2 inhibitor-induced ketoacidosis in patients with metabolic acidosis.

    Implications:

    • Anesthesiologists and critical care physicians must be aware of SGLT2 inhibitors' pharmacologic properties and risk profile.
    • Withholding SGLT2 inhibitors during catabolic conditions, such as perioperative stress, is crucial.
    • Prompt diagnosis and management of euglycemic ketoacidosis are vital to prevent life-threatening outcomes.