Perioperative Implication of Sodium-glucose Cotransporter-2 Inhibitor in a Patient Following Major Surgery

Vidhyadhar Lad; Dheeraj Kapoor

doi:10.5005/jp-journals-10071-23929

SEARCH WITHIN CONTENT

Online First

Perioperative Implication of Sodium-glucose Cotransporter-2 Inhibitor in a Patient Following Major Surgery

Vidhyadhar Lad, Dheeraj Kapoor

Citation Information : Lad V, Kapoor D. Perioperative Implication of Sodium-glucose Cotransporter-2 Inhibitor in a Patient Following Major Surgery. Indian J Crit Care Med 2021; 25 (8):958-959.

DOI: 10.5005/jp-journals-10071-23929

License: CC BY-NC 4.0

Published Online: 12-08-2021

ARTICLE
REFERENCES

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are the second line of therapy in diabetes mellitus type 2. They are frequently coprescribed with other noninsulin glucose-lowering medications. Diabetic ketoacidosis (DKA) with lower-than-anticipated glucose levels is an important SGLT2i-related adverse effect in postoperative patients. This case highlights the need for increased postoperative surveillance of patients on this group of medications. Ketonuria was managed with short-acting insulin infusion with dextrose-containing intravenous fluid, as a part of the ongoing intensive care treatment to which the patient responded well. Awareness of DKA with lower-than-anticipated glucose levels is an important clinical challenge, an entity that can be confused in the setting of major and complex surgeries. The frequency of this arcane and underreported diagnosis in the perioperative setting is unknown.

HTML PDF Share

Milder DA, Milder TY, Kam PCA. Sodium-glucose cotransporter type-2 inhibitors: pharmacology and perioperative considerations. Anaesthesia 2018;73:1008e18. DOI: 10.1111/anae.14251.
Goldenberg RM, Berard LD, Cheng AY, Gilbert JD, Verma S, Woo VC, et al. SGLT2 inhibitor–associated diabetic ketoacidosis: Clinical review and recommendations for prevention and diagnosis. Clin Ther 2016;38(2654–64): e1. DOI: 10.1016/j.clinthera.2016.11.002.
Handelsman Y, Henry RR, Bloomgarden ZT, Dagogo-Jack S, DeFronzo RA, Einhorn D, et al. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the association of sglt-2 inhibitors and diabetic ketoacidosis. Endocr Pract 2016;22:753–762. DOI: 10.4158/ep161292.ps.
https://www.medscape.com/viewarticle/927047.
Pujara S, Ioachimescu A. Prolonged ketosis in a patient with euglycemic diabetic ketoacidosis secondary to dapagliflozin. J Investig Med High Impact Case Rep 2017;5(2):2324709617710040. DOI: 10.1177/2324709617710040.

PDF Share