Endocrine Abstracts

Canagliflozin is an oral hypoglycemic agent from the novel class of Sodium Glucose co-Transporter 2 (SGLT2) inhibitors, used in the treatment of patients with Type 2 Diabetes Mellitus (T2DM). Although effective in treatment of hyperglycemia, these medications have been linked to development of diabetic ketoacidosis (DKA) in patients with T2DM. We describe the case of a patient with T2DM, who presented with severe metabolic acidosis while taking Canagliflozin.

SGLT-2 Inhibitors prevent glucose resorption from urine, leading to increased urinary glucose clearance and subsequent improvement of glycaemic control. Nonetheless, in May 2015, the FDA published a safety warning for this class of drugs, reporting over 20 cases of DKA in patients taking the medication.

We report the case of a 43-year-old Caucasian male with T2DM who presented with vomiting, dehydration, fatigue, and abdominal pain. He had been prescribed Canagliflozin four months earlier. The patient was found to have a severe metabolic acidosis, with high urinary ketones but normal blood glucose levels. He was haemodynamically stable at presentation, and remained so throughout admission. Treatment with intravenous insulin, fluids and sodium bicarbonate resolved the acidosis, and canagliflozin was stopped.

It is important for clinicians and patients to be aware of the potential risk of euglycaemic DKA in patients taking SGLT2 inhibitors. Acute illness, dehydration and relative insulinopenia may be predisposing factors. Whether supplying patients prescribed with these medications with ketone meters could help prevent DKAs, or lead to earlier admissions, merits further research.