Endocrine Abstracts

Introduction: DKA is often seen in people with Diabetes Mellitus I and seldom in Diabetes Mellitus II but rarely seen in Maturity Onset Diabetes of Young (MODY) and even more rare in association with SGLT2i.

Case history: 44 years female, genetically confirmed Hepatocyte Nuclear Factor 1 alpha (HNF1A) MODY since 2004 initially treated with maximum doses of metformin and gliclazide and then lost to follow-up. GP initiated Empagliflozin a year before presentation due to suboptimal diabetes control. There was no previous history of DKA. Her mother and grandmother also had MODY. She presented to accident and emergency with nausea, vomiting, abdominal pain and unable to tolerate any fluids. She was hemodynamically stable but her blood results confirmed severe DKA (with hyperglycaemia). Empagliflozin (SGLT2i) was stopped and local DKA protocol was commenced. She was later transferred to high dependency area for monitoring purposes due to severity of DKA and very slow resolution of ketosis but did not require cardiovascular or respiratory support. She gradually improved clinically and biochemically without any complications and discharged on gliclazide and metformin with stable glycaemic control on out-patient follow-up.

Investigations: Full blood count showed raised white cells count but normal C-reactive protein. Renal, liver, coagulation profile and Chest X-Ray were normal. Blood glucose: 21.9 mmol/l; pH: 6.83; HCO3: 1.9 mmol/l; Ketones: 5.2 mmol/l Pre-admission HbA1c: 39 mmol/mol 3 month post-admission HbA1c: 44 mmol/mol

Results and treatment: Local DKA protocol resulted in complete resolution of DKA without any complications and SGLT2i was discontinued.

Conclusions and points for discussion: • Historically, DKA was considered as one of the exclusion criteria for MODY but several reported cases resulted in omission of this criterion.

• MODY patients are equally at risk of DKA therefore decision regarding SGLT-2i like empagliflozin should be cautiously considered.

• Management remains same as for standard DKA besides discontinuing SGLT2i.