PMID- 33851013
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220422
IS  - 2376-0605 (Electronic)
IS  - 2376-0605 (Linking)
VI  - 7
IP  - 1
DP  - 2021 Jan-Feb
TI  - Euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors and a Ketogenic Diet: 
      A Case Series and Review of Literature.
PG  - 17-19
LID - 10.1016/j.aace.2020.11.009 [doi]
AB  - OBJECTIVE: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a relatively 
      novel class of oral medications for the treatment of type 2 diabetes mellitus 
      (T2DM). Their use has increased recently due to their beneficial renal and 
      cardiovascular outcomes, but they come with the rare risk of diabetic 
      ketoacidosis (DKA) at normal or slightly elevated glucose values, termed 
      euglycemic DKA (euDKA). Recently, carbohydrate-deprived, ketogenic diets have 
      gained popularity due to benefits of weight loss and improved control of T2DM. We 
      describe 2 patients with T2DM who developed euDKA caused by SGLT2 inhibitor use 
      while on a ketogenic diet and provide a review of the literature. METHODS: We 
      describe the hospital course, laboratory data, and treatment of 2 patients and 
      provide a literature review. RESULTS: Both of our patients were found to have 
      normal or mildly elevated serum glucose levels, with an elevated anion gap and 
      ketosis, representative of euDKA. The first patient developed euDKA after only 1 
      dose of empagliflozin, while the second patient developed euDKA after only 1 week 
      of being on a ketogenic diet while on an SGLT2 inhibitor. CONCLUSION: While there 
      have been a few reports of euDKA with SGLT2 inhibitors and ketogenic diets, many 
      physicians prescribing these medications may not be aware of this association. 
      Therefore, they must inform their patients to avoid a ketogenic diet if on an 
      SGLT2 inhibitor. If a patient presents with symptoms of DKA and is eating a 
      carbohydrate-free diet while taking an SGLT2 inhibitor, there should be a low 
      threshold to screen for DKA.
CI  - (c) 2020 AACE. Published by Elsevier Inc.
FAU - Mistry, Serena
AU  - Mistry S
AD  - Stony Brook Medicine Department of Internal Medicine, Stony Brook University 
      Hospital, Stony Brook, New York.
FAU - Eschler, Deirdre Cocks
AU  - Eschler DC
AD  - Stony Brook Medicine Department of Endocrinology, Stony Brook University 
      Hospital, Stony Brook, New York.
LA  - eng
PT  - Case Reports
DEP - 20201228
PL  - United States
TA  - AACE Clin Case Rep
JT  - AACE clinical case reports
JID - 101670593
PMC - PMC7924151
OTO - NOTNLM
OT  - DKA, diabetic ketoacidosis
OT  - HbA1C, hemoglobin A1C
OT  - SGLT2 inhibitor
OT  - SGLT2, sodium-glucose cotransporter-2
OT  - T1DM, type 1 diabetes mellitus
OT  - T2DM, type 2 diabetes mellitus
OT  - euDKA, euglycemic DKA, decarboxylase
OT  - euglycemic DKA
OT  - ketogenic diet
EDAT- 2021/04/15 06:00
MHDA- 2021/04/15 06:01
PMCR- 2020/12/28
CRDT- 2021/04/14 06:36
PHST- 2021/04/14 06:36 [entrez]
PHST- 2021/04/15 06:00 [pubmed]
PHST- 2021/04/15 06:01 [medline]
PHST- 2020/12/28 00:00 [pmc-release]
AID - S2376-0605(20)31010-5 [pii]
AID - 10.1016/j.aace.2020.11.009 [doi]
PST - epublish
SO  - AACE Clin Case Rep. 2020 Dec 28;7(1):17-19. doi: 10.1016/j.aace.2020.11.009. 
      eCollection 2021 Jan-Feb.