Abstract：
We herein present the case of a 45-year-old diabetic woman who developed diabetic ketoacidosis following the administration of dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor. The patient had been diagnosed with diabetes three years previously and was being treated with multiple daily injections of insulin. Metformin hydrochloride and dapagliflozin were added seven months and 11 months later, respectively. Her clinical course was uneventful until the onset of influenza. She then discontinued insulin and oral medications voluntarily. On arrival at the hospital, she was found to be in a state of ketoacidosis, and promptly received insulin and saline infusion. In retrospect, the initial amount of glucose infused was insufficient, and the hypoglycemia was thought to have been prolonged. This phenomenon may also have affected her long-term urinary glucose excretion. Her urinary L-type fatty acid-binding protein (L-FABP) level was found to be markedly elevated (48.8 μg/g·Cr, reference value < 8.4 μg/g·Cr) as was her urinary β2-microglobulin level (9,230 μg/L, reference value < 230 μg/L). Patients with SGLT-2 inhibitor-associated diabetic ketoacidosis often exhibit protracted hyperglycosuria, in which acute proximal renal tubular dysfunction is considered to be etiologically implicated.
摘要：
我们在此介绍了一名45岁的糖尿病妇女在服用达格列净后出现糖尿病酮症酸中毒的情况，钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂。该患者三年前被诊断患有糖尿病，并每天多次注射胰岛素。7个月和11个月后分别加用盐酸二甲双胍和达格列净,分别。在流感发作之前，她的临床过程一直很顺利。然后她自愿停止胰岛素和口服药物。一到达医院，她被发现处于酮症酸中毒状态,并及时接受胰岛素和生理盐水输注。回想起来，最初输入的葡萄糖量不足，低血糖被认为已经延长。这种现象也可能影响了她的长期尿葡萄糖排泄。发现她的尿L型脂肪酸结合蛋白（L-FABP）水平显着升高（48.8μg/g·Cr，参考值<8.4μg/g·Cr），以及她的尿β2-微球蛋白水平（9,230μg/L，参考值<230μg/L)。SGLT-2抑制剂相关的糖尿病酮症酸中毒患者常表现为持续性高糖尿，其中急性近端肾小管功能障碍被认为与病因有关。
