Pathogenesis of euglycemic ketoacidosis associated with SGLT2
inhibitors

J 2024

Pathogenesis of euglycemic ketoacidosis associated with SGLT2 inhibitors

ŠITINA, Michal and Vladimír ŠRÁMEK

Basic information

Original name

Pathogenesis of euglycemic ketoacidosis associated with SGLT2 inhibitors

Authors

ŠITINA, Michal (203 Czech Republic, belonging to the institution) and Vladimír ŠRÁMEK (203 Czech Republic)

Edition

Anesteziologie a intenzivní medicína, Praha, Česká lékařská společnost J.E. Purkyně, 2024, 1214-2158

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30223 Anaesthesiology

Country of publisher

Czech Republic

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 0.100 in 2022

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.36290/aim.2024.018

UT WoS

001284895400003

Keywords in English

gliflozins; SGLT2 inhibitors; euglycemic ketoacidosis; hyperchloremic acidosis; diabetes mellitus

Abstract

V originále

Euglycemic ketoacidosis associated with SGLT2 inhibitors, also referred to as gliflozins, is a rare but potentially fatal clinical entity characterized by metabolic acidosis with normal or only mildly elevated glycemia, predominantly in patients with type 2 diabetes mellitus. In addition to ketoacidosis, hyperchloremic acidosis may also contribute significantly to metabolic acidosis. Relative hypoglycemia induced by gliflozins and concomitant stress condition lead to decreased insulin level and increased glucagon, cortisol, and catecholamines, which stimulates ketogenesis. At the same time, gliflozins induce complex renal metabolic dysfunction, in particular impaired renal elimination of acids and renal ammoniogenesis, resulting in hyperchloremic acidosis. In patients treated with gliflozins, acid-base balance and ketonemia should be checked in a timely manner when their condition worsens. Treatment of acidosis consists of discontinuation of gliflozin and administration of insulin at a dose sufficient to suppress ketogenesis. Because of the risk of acidosis, gliflozins should be discontinued at least 3 days before elective surgery and resumed only after stabilization and reliable restoration of oral intake. Similarly, gliflozins should be discontinued in most hospitalized nonsurgical patients with risk factors for the development of acidosis, such as in patients with acute infection, acute heart disease, stroke, fasting before examination, or alcohol abuse.

Citovat

ŠITINA, Michal and Vladimír ŠRÁMEK. Pathogenesis of euglycemic ketoacidosis associated with SGLT2 inhibitors. Anesteziologie a intenzivní medicína. Praha: Česká lékařská společnost J.E. Purkyně, 2024, vol. 35, No 2, p. 98-103. ISSN 1214-2158. Available from: https://dx.doi.org/10.36290/aim.2024.018.

@article{2424279,
   author = {Šitina, Michal and Šrámek, Vladimír},
   article_location = {Praha},
   article_number = {2},
   doi = {http://dx.doi.org/10.36290/aim.2024.018},
   keywords = {gliflozins; SGLT2 inhibitors; euglycemic ketoacidosis; hyperchloremic acidosis; diabetes mellitus},
   language = {eng},
   issn = {1214-2158},
   journal = {Anesteziologie a intenzivní medicína},
   title = {Pathogenesis of euglycemic ketoacidosis associated with SGLT2 inhibitors},
   url = {https://www.aimjournal.cz/en/artkey/aim-202402-0002_pathogenesis-of-euglycemic-ketoacidosis-associated-with-sglt2-inhibitors.php?l=en},
   volume = {35},
   year = {2024}
}

TY  - JOUR
ID  - 2424279
AU  - Šitina, Michal - Šrámek, Vladimír
PY  - 2024
TI  - Pathogenesis of euglycemic ketoacidosis associated with SGLT2 inhibitors
JF  - Anesteziologie a intenzivní medicína
VL  - 35
IS  - 2
SP  - 98-103
EP  - 98-103
PB  - Česká lékařská společnost J.E. Purkyně
SN  - 12142158
KW  - gliflozins
KW  - SGLT2 inhibitors
KW  - euglycemic ketoacidosis
KW  - hyperchloremic acidosis
KW  - diabetes mellitus
UR  - https://www.aimjournal.cz/en/artkey/aim-202402-0002_pathogenesis-of-euglycemic-ketoacidosis-associated-with-sglt2-inhibitors.php?l=en
N2  - Euglycemic ketoacidosis associated with SGLT2 inhibitors, also referred to as gliflozins, is a rare but potentially fatal clinical entity characterized by metabolic acidosis with normal or only mildly elevated glycemia, predominantly in patients with type 2 diabetes mellitus. In addition to ketoacidosis, hyperchloremic acidosis may also contribute significantly to metabolic acidosis. Relative hypoglycemia induced by gliflozins and concomitant stress condition lead to decreased insulin level and increased glucagon, cortisol, and catecholamines, which stimulates ketogenesis. At the same time, gliflozins induce complex renal metabolic dysfunction, in particular impaired renal elimination of acids and renal ammoniogenesis, resulting in hyperchloremic acidosis. In patients treated with gliflozins, acid-base balance and ketonemia should be checked in a timely manner when their condition worsens. Treatment of acidosis consists of discontinuation of gliflozin and administration of insulin at a dose sufficient to suppress ketogenesis. Because of the risk of acidosis, gliflozins should be discontinued at least 3 days before elective surgery and resumed only after stabilization and reliable restoration of oral intake. Similarly, gliflozins should be discontinued in most hospitalized nonsurgical patients with risk factors for the development of acidosis, such as in patients with acute infection, acute heart disease, stroke, fasting before examination, or alcohol abuse.
ER  -

ŠITINA, Michal and Vladimír ŠRÁMEK. Pathogenesis of euglycemic ketoacidosis associated with SGLT2 inhibitors. \textit{Anesteziologie a intenzivní medicína}. Praha: Česká lékařská společnost J.E. Purkyně, 2024, vol.~35, No~2, p.~98-103. ISSN~1214-2158. Available from: https://dx.doi.org/10.36290/aim.2024.018.

Detailed Information on Publication Record