PMID- 37681058
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230909
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 8
DP  - 2023 Aug
TI  - Unsuspected diabetic ketoacidosis after myocardial infarction in a patient 
      treated with SGLT2 inhibitor increased length of stay in the hospital: how can it 
      be prevented? A case report.
PG  - ytad336
LID - 10.1093/ehjcr/ytad336 [doi]
LID - ytad336
AB  - BACKGROUND: As the use of sodium-glucose co-transporter 2 inhibitors (SGLT2is) 
      has expanded beyond glucose-lowering therapy in type 2 diabetes mellitus (T2DM), 
      including chronic kidney disease and heart failure, there has also been an 
      increase in reported cases of diabetic ketoacidosis (DKA) associated with SGLT2i. 
      CASE SUMMARY: A 77-year-old woman with T2DM presented to the emergency department 
      with ST-segment elevation myocardial infarction (MI) complicated by atrial 
      fibrillation. Her medications included empagliflozin, an SGLT2i, initiated for 
      T2DM. Diabetic ketoacidosis was suspected on the basis of a large anion gap, 
      despite a plasma glucose level below 200 mg/dL (11.1 mmol/L) and the absence of 
      symptoms, including nausea and vomiting. Laboratory tests confirmed metabolic 
      acidosis and high ketones. However, the diagnosis of euglycaemic DKA (eu-DKA) was 
      delayed due to lack of symptoms and moderate hyperglycaemia. The patient was 
      successfully treated according to DKA management guidelines. She was discharged 
      on insulin, and SGLT2i was discontinued. DISCUSSION: This is a case of 
      asymptomatic eu-DKA after acute MI (AMI). We discuss the use of SGLT2is in AMI 
      and arrhythmias from a review of the literature and the prophylaxis of eu-DKA. 
      Regular monitoring of blood glucose and ketones should be performed in 
      hospitalized T2DM patients treated with SGLT2i. The SGLT2i should be stopped as 
      soon as possible in the event of critical illness or suspected DKA in the setting 
      of an acute illness such as AMI. To help clinicians prevent this potentially 
      fatal disease, we propose a flowchart for the prophylactic management of eu-DKA 
      among inpatients.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Oriot, Philippe
AU  - Oriot P
AUID- ORCID: 0000-0002-9810-0303
AD  - Department of Diabetology, Mouscron Hospital Centre, Avenue de Fecamp 49, 7700 
      Mouscron, Belgium.
FAU - Hermans, Michel P
AU  - Hermans MP
AUID- ORCID: 0000-0002-1647-9031
AD  - Division of Endocrinology & Nutrition, Universite catholique de louvain, Avenue 
      Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
AD  - IREC - Institut de Recherche Experimentale et Clinique Avenue Hippocrate, 55 bte 
      B1.55.02 - 1200 Woluwe-Saint-Lambert - Belgium.
FAU - Beauloye, Christophe
AU  - Beauloye C
AD  - Division of Cardiology, Universite catholique de louvain, Avenue Hippocrate 10, 
      1200 Woluwe-Saint-Lambert, Brussels, Belgium.
AD  - IREC - Institut de Recherche Experimentale et Clinique Avenue Hippocrate, 55 bte 
      B1.55.02 - 1200 Woluwe-Saint-Lambert - Belgium.
FAU - Rogghe, Pierre-Arnaud
AU  - Rogghe PA
AD  - Department of Critical Care Unit, Mouscron Hospital Centre, Avenue de Fecamp 49, 
      7700 Mouscron, Belgium.
FAU - Noel, Sophie
AU  - Noel S
AD  - Universite Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 
      Brussels, Belgium.
FAU - Paternotte, Emmanuelle
AU  - Paternotte E
AD  - Department of Cardiology, Mouscron Hospital Centre, Avenue de Fecamp 49, 7700 
      Mouscron, Belgium.
LA  - eng
PT  - Case Reports
DEP - 20230725
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC10481769
OTO - NOTNLM
OT  - Acute myocardial infarction
OT  - Case report
OT  - Diabetic ketoacidosis
OT  - Sodium-glucose co-transporter 2 inhibitor
OT  - Type 2 diabetes mellitus
COIS- Conflict of interest: None declared.
EDAT- 2023/09/08 06:42
MHDA- 2023/09/08 06:43
PMCR- 2023/07/25
CRDT- 2023/09/08 04:11
PHST- 2023/02/03 00:00 [received]
PHST- 2023/07/05 00:00 [revised]
PHST- 2023/07/19 00:00 [accepted]
PHST- 2023/09/08 06:43 [medline]
PHST- 2023/09/08 06:42 [pubmed]
PHST- 2023/09/08 04:11 [entrez]
PHST- 2023/07/25 00:00 [pmc-release]
AID - ytad336 [pii]
AID - 10.1093/ehjcr/ytad336 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Jul 25;7(8):ytad336. doi: 10.1093/ehjcr/ytad336. 
      eCollection 2023 Aug.