Abstract | RATIONALE: PATIENT CONCERNS: DIAGNOSES: Arterial blood gases showed a picture of severe metabolic acidosis with an elevated anion gap, while ketones were elevated in blood and positive in urine. Blood glucose was mildly elevated at 180 mg/dL. Serum lactate levels were normal. Our patient was thus diagnosed with eDKA. INTERVENTION: Our patient was promptly admitted to the intensive care unit and treated for eDKA through intravenous rehydration therapy with insulin infusion. OUTCOMES: Serial blood gas analyses showed gradual resolution of the patient's ketoacidosis with normalized anion gap and clearance of serum ketones. She was discharged uneventfully on day 4, with permanent cessation of dapagliflozin administration. LESSONS: Life-threatening eDKA as a complication of dapagliflozin is a challenging and easilymissed diagnosis in the ED. Such an ED presentation is very rare, nevertheless emergency physicians are reminded to consider the diagnosis of eDKA in a patient whose drug regimen includes any SGLT2 inhibitor, especially if the patient presents with nausea, vomiting, abdominal pain, dyspnea, lethargy, and is clinically dehydrated. These patients should then be investigated with ketone studies and blood gas analyses regardless of blood glucose levels for prompt diagnosis and treatment.
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Authors | Yu-Mou Chou, Chen-June Seak, Zhong Ning Leonard Goh, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chih-Chuan Lin |
Journal | Medicine
(Medicine (Baltimore))
Vol. 97
Issue 25
Pg. e11056
(Jun 2018)
ISSN: 1536-5964 [Electronic] United States |
PMID | 29923997
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Benzhydryl Compounds
- Glucosides
- Hypoglycemic Agents
- dapagliflozin
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Topics |
- Abdominal Pain
(etiology)
- Benzhydryl Compounds
(adverse effects)
- Diabetes Mellitus, Type 2
(drug therapy)
- Diabetic Ketoacidosis
(chemically induced, complications, drug therapy)
- Dyspnea
(etiology)
- Fatigue
(etiology)
- Female
- Glucosides
(adverse effects)
- Humans
- Hypoglycemic Agents
(adverse effects)
- Middle Aged
- Nausea
(etiology)
- Vomiting
(etiology)
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