Endocrine Abstracts

Intro: Diabetic Ketoacidosis (DKA) is a medical emergency characterised by hyperglycemia, ketosis and acidosis. If left untreated it can lead to cerebral oedema, acute kidney injury, Adult Respiratory Distress Syndrome andeven death. Euglycaemic DKA (EuDKA) without hyperglycaemia is rare but increasing cases of EuDKAbeing reported in patients taking SGLT2 inhibitors.

Case report: A 53 year old, Type 2 Diabetic was admitted for an elective cholecystecomy. He had a background history of Oesphageal cancer, previous trans-hiatel oesphagecomy, hypertension, and high cholesterol. His diabetic medications included Metformin 1 g BD, Linagliptan 5 mg OD and Empagliflozin 25 mg OD PO. He Smoked 20 cigarettes a day, drank 10 units per week. He was a retired chef and lived with his wife and daughter. He had no family history of type 1 or 2 diabetes. The patient successfully had his gallbladder removed however he had still not recovered on day 3 post-op. He reported to his surgical team that since the surgery he was very Nauseous and was ‘feeling dreadful’. He had not been eating or drinking but had still taking all his medications. His surgical site looked clean and he had a CT Abdomen, which was normal. The patient was then seen by the Medical Registrar who did a Venous Blood Gas which showed a severe metabolic acidosis (Ph: 7.04, HCO3: 4.3, pCO2: 2.16, Lactate: 1.93) with a raised anion gap of 18. His Blood Glucose was only 13mmol/lhowever his blood ketones were 4.5. The patient was promptly diagnosed as having a severe euDKA and started urgently on the DKA treatment protocol, his SGLT-2 inhibitor was held and he was transferred to a High Dependency Unit for close monitoring. The patient made a full recovery and was discharged a week later.

Conclusions: SGLT-2 Inhibitors are very popular and effective drugs for use in Type 2 Diabetics. They promote HbA1c reductions, weight loss as well as improved cardiovascular and renal outcomes. There are an increasingly wide range of SGLT-2 Inhibitors available. This case demonstrates the dangers posed by poor education about these drugs among our Diabetic patientsand non-diabetologist colleagues. Poor education aboutthe importance of stopping SGLT-2 Inbibitors when patients are unwell, fasting or going for surgery can lead to repeat hospitals admissions, prolonged hospital stays and potential morbidity and mortality.