Lakušić N, Sopek Merkaš I, Slišković AM, Cerovec D. Euglycemic diabetic ketoacidosis: A rare but serious side effect of sodium-glucose co-transporter 2 inhibitors. World J Cardiol 2022; 14(10): 561-564 [PMID: 36339887 DOI: 10.4330/wjc.v14.i10.561]
Corresponding Author of This Article
Ivana Sopek Merkaš, MD, Doctor, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, 2 Gajeva, Krapinske Toplice 49217, Croatia. ivana.sopek@sbkt.hr
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Oct 26, 2022; 14(10): 561-564 Published online Oct 26, 2022. doi: 10.4330/wjc.v14.i10.561
Euglycemic diabetic ketoacidosis: A rare but serious side effect of sodium-glucose co-transporter 2 inhibitors
Nenad Lakušić, Ivana Sopek Merkaš, Ana Marija Slišković, Dora Cerovec
Nenad Lakušić, Ivana Sopek Merkaš, Dora Cerovec, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
Nenad Lakušić, Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
Nenad Lakušić, Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osijek 31000, Croatia
Ana Marija Slišković, Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Author contributions: Lakušić N, Sopek Merkaš I, Slišković AM were responsible for the conception and design of the manuscript, literature review, and they wrote the first original draft; Lakušić N and Cerovec D contributed in acquisition of data, analysis and interpretation, literature review, and making critical revisions related to the important intellectual content of the manuscript; all authors gave final approval for the final version of the article to be published.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ivana Sopek Merkaš, MD, Doctor, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, 2 Gajeva, Krapinske Toplice 49217, Croatia. ivana.sopek@sbkt.hr
Received: July 10, 2022 Peer-review started: July 10, 2022 First decision: August 22, 2022 Revised: August 29, 2022 Accepted: September 21, 2022 Article in press: September 21, 2022 Published online: October 26, 2022 Processing time: 101 Days and 3.6 Hours
Abstract
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an insulin-independent class of oral antihyperglycemic medication and from recently established therapy in chronic heart failure patients. A rare, but potentially life-threatening complication of SGLT2 inhibitor use is euglycemic diabetic ketoacidosis. We described a case of a middle-aged male patient with type 2 diabetes who developed metabolic ketoacidosis after a few days of empagliflozin administration. SGLT2 inhibitor related ketoacidosis presents with euglycemia or only modestly elevated glucose blood concentrations, which causes delayed detection and treatment of ketoacidosis. There are multiple possible risk factors and mechanism that might contribute to the pathogenesis of ketoacidosis. It is implied that SGLT2 inhibitor use and prescription by non-diabetologists (cardiologists, nephrologists, family physicians, etc.) will continue to grow in the future. It is important to inform the general cardiac public about this rare but serious side effect of SGLT2 inhibitors.
Core Tip: Sodium-glucose co-transporter 2 inhibitors have recently become an established treatment for most chronic heart failure (CHF) patients (with and without diabetes), and it is important for the cardiologist to know their side effects, including those that are rare, but serious, like euglycemic ketoacidosis. In this way, an unwanted outcome of CHF treatment can be avoided.