Euglycemic diabetic ketoacidosis in patients with postoperation stroke, taking SGLT2 inhibitor

초록

Purpose: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus that occasionally can become fatality. Although DKA is usually associated with severe hyperglycemia and dehydration, it can occur rarely in the setting of normal glucose concentrations, known as euglycemic DKA, defined as DKA with a blood glucose level of <300 mg/dL. Euglycemic DKA develops mostly in individuals with type 1 diabetes, or pregnant diabetic women. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are new oral hypoglycemic drugs indicated for type 2 diabetes mellitus The drugs have a relatively pronounced glucose-lowering effect with a low risk of hypoglycemia and could reduces body weight and has pleiotropic effects attributable to amelioration of insulin resistance, dyslipidemia, nonalcoholic fatty liver disease, congestive heart failure and cardiovascular diseases. We present a case of a woman with type 2 diabetes mellitus hospitalized for postoperation stroke, who developed empagliflozin- associated euglycemic diabetic ketoacidosis Methods: Here, we describes a 69-year-old woman diagnosed with type 2 diabetes mellitus (DM) who presented with left midbrain infarction during operation for intertrochanter fracture in other hospital and then was transferred to our hospital. On admission, she had euglycemic DKA and she had the history of medication of empagliflozin for one month. The Hba1c level was 12.1% and the ketone serum level of ketone body was over 9600 mmol/L. After hydration, the laboratory findings did not improved. After 3 days of discontinuation of empagliflozin, ketone bodies decreased to less than 200 mmol/L. Results: Surgical stress, and decreased carbohydrate intake also could be contributing factors to the development of ketosis in this patient. Early recognition of this medical emergency like euglycemic DKA and timely intervention can reduce the consequences of serious complication. However, this form of DKA could be missed by