PDF(Pubmed)
Abstract：
Euglycemic diabetic ketoacidosis (euDKA) is a rare but deadly complication of sodium-glucose cotransport-2 (SGLT-2) inhibitors. Primarily indicated for the treatment of Type 2 Diabetes Mellitus, the incidence of euDKA is expected to rise as SGLT-2 inhibitors become a mainstay therapy for diabetics with heart failure. Diagnosis of euDKA can be difficult given the presence of normoglycemia and is especially challenging among geriatric patients that are complicated by additional comorbidities. We present a case of an elderly male with multiple comorbidities who presented for dehydration and altered mentation from a nursing home facility. Laboratory investigations showed signs of acute renal failure, uremia, electrolyte abnormalities, and severe metabolic acidosis due to high levels of plasma beta-hydroxybutyrate. He was admitted to the medical intensive care unit (ICU) for further management. A presumptive diagnosis of euDKA was strongly suspected due to his laboratory data and medication reconciliation which revealed the recent initiation of empagliflozin. The patient was promptly started on a standardized treatment protocol for DKA with continuous infusion of regular insulin with strict glucose monitoring, along with intravenous fluids, and a small dose of sodium bicarbonate infusion as per current standard guidelines. With the rapid improvement in symptoms and metabolic derangements, the diagnosis was confirmed. Geriatric patients from nursing home facilities are a high-risk cohort who if not properly cared for by nursing staff can develop dehydration, malnutrition and worsening frailty including sarcopenia that exposes them to increased risk of medication side effects, such as euDKA. Clinicians should consider euDKA in their differential diagnosis in elderly patients with overt or relative insulinopenia who are receiving SGLT-2 inhibitors when presenting with acute changes in health and mentation.
摘要：
正常血糖糖尿病酮症酸中毒（euDKA）是钠-葡萄糖共转运2（SGLT-2）抑制剂的罕见但致命的并发症。主要用于治疗2型糖尿病，随着SGLT-2抑制剂成为糖尿病合并心力衰竭的主要治疗药物,euDKA的发病率有望上升.鉴于血糖正常的存在，eDKA的诊断可能很困难，并且在因其他合并症而复杂化的老年患者中尤其具有挑战性。我们介绍了一例患有多种合并症的老年男性，他从疗养院因脱水和状态改变而出现。实验室检查显示有急性肾衰竭的迹象,尿毒症,电解质异常，和严重的代谢性酸中毒由于高水平的血浆β-羟丁酸。他被送进重症监护室（ICU）接受进一步治疗。由于他的实验室数据和药物和解表明最近开始使用依帕列净，因此强烈怀疑eudka的推定诊断。患者立即开始接受DKA的标准化治疗方案，并在严格的血糖监测下连续输注常规胰岛素，连同静脉注射液，并按照现行标准指南进行小剂量碳酸氢钠输注。随着症状和代谢紊乱的迅速改善，诊断得到证实。来自疗养院的老年患者是高风险人群，如果护理人员没有适当的护理，可能会出现脱水，营养不良和日益恶化的虚弱，包括肌肉减少症，使他们面临药物副作用的风险增加，比如euDKA。在接受SGLT-2抑制剂的明显或相对胰岛素减少的老年患者中，当出现健康和心理急性变化时，临床医生应考虑euDKA的鉴别诊断。
