Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis

ŠITINA, Michal, Marek LUKEŠ and Vladimír ŠRÁMEK. Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis. BMC ENDOCRINE DISORDERS. LONDON: BMC, 2023, vol. 23, No 1, p. 1-6. ISSN 1472-6823. Available from: https://dx.doi.org/10.1186/s12902-023-01339-w.

Basic information

• Original name: Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis
• Authors: ŠITINA, Michal (203 Czech Republic, guarantor, belonging to the institution), Marek LUKEŠ (203 Czech Republic, belonging to the institution) and Vladimír ŠRÁMEK (203 Czech Republic, belonging to the institution).
• Edition: BMC ENDOCRINE DISORDERS, LONDON, BMC, 2023, 1472-6823.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30202 Endocrinology and metabolism
• Country of publisher: United Kingdom of Great Britain and Northern Ireland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 2.700 in 2022
• RIV identification code: RIV/00216224:14110/23:00133368
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1186/s12902-023-01339-w
• UT WoS: 000971725600002
• Keywords in English: Empagliflozin; SGLT2 inhibitor; Euglycemic ketoacidosis; Hyperchloremic acidosis; Case report
• Tags: 14110122, rivok
• Tags: International impact, Reviewed

Abstract

BackgroundEuglycemic diabetic ketoacidosis associated with SGLT2 inhibitors is a rare, relatively new and potentially fatal clinical entity, characterized by metabolic acidosis with normal or only moderately elevated glycemia. The mechanisms are not fully understood but involve increased ketogenesis and complex renal metabolic dysfunction, resulting in both ketoacidosis and hyperchloremic acidosis. We report a rare case of fatal empagliflozin-associated acidosis with profound hyperchloremia and review its pathogenesis.Case presentationA patient with type 2 diabetes mellitus treated with empagliflozin underwent an elective hip replacement surgery. Since day 4 after surgery, he felt generally unwell, leading to cardiac arrest on the day 5. Empagliflozin-associated euglycemic diabetic ketoacidosis with severe hyperchloremic acidosis was identified as the cause of the cardiac arrest.ConclusionsThis unique case documents the possibility of severe SGLT2 inhibitor-associated mixed metabolic acidosis with a predominant hyperchloremic component. Awareness of this possibility and a high index of suspicion are crucial for correct and early diagnosis.