Medical Minute: Euglycemic DKA (euDKA)

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August 18, 2015 by dailybolusoflr

By: Karolina DeAugustinis, MD

Definition?
  • DKA with Serum glucose <200 mg/dl

Cause?
  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors – hypoglycemic drugs that prevent the reabsorption of glucose from primary urine at the proximal renal tubules. Used off-label in IDDM also. Promote weight loss, insulin doses and reduce glycemic variability. Low hypoglycemic risk.
  • i.e. Canagliflozin, invokana, dapagliflozin
  • Mechanism not well understood – possible urinary loss of glucose uncouples DKA from hyperglycemia. Loss of sodium & glucose compounds hypoglycemia.

Presentation?
  • Vomiting (~30%)
  • Malaise
  • Metabolic ketoacidosis

Who?
  • Both Type 1 and Type 2 Diabetics
  • Increasing case reports, new trend, unclear incidence

Management?
  • DKA management (insuling gtt)
  • SGLT2 inhibitors should be withheld in symptomatic patients or patients with ketonuira or ketonemia

References
  1. Ogawa, W., & Sakaguchi, K. (2015). Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. Journal of Diabetes Investigation.
  2. St Hilaire, R., & Costello, H. (2015). Prescriber beware: report of adverse effect of sodium-glucose cotransporter 2 inhibitor use in a patient with contraindication. The American journal of emergency medicine, 33(4), 604-e3.
  3. Peters, A. L., Buschur, E. O., Buse, J. B., Cohan, P., Diner, J. C., & Hirsch, I. B. (2015). Euglycemic diabetic ketoacidosis: A potential complication of treatment with sodium-glucose cotransporter 2 inhibition. Diabetes care, dc150843.

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