PDF(Pubmed)
Abstract：
Euglycemic diabetic ketoacidosis (eDKA) has emerged as an adverse event associated with sodium-glucose transporter-2 inhibitors (SGLT2i). We present two consecutive cases of SGLT2i-induced eDKA, both manifested as life-threatening coronary vasospastic angina (VSA). Case 1: A 64-year-old male overweight patient with type 2 diabetes (BMI 28.2 kg/m2), treated with dapagliflozin 5 mg daily for 6 months and a restricted diet for 2 months, experienced loss of consciousness following severe chest pain while driving, resulting in a traffic accident: plasma glucose, 163 mg/dL; urine ketones, (+++); bicarbonate (HCO3-), 13.2 mmol/L; and total ketone body, 1539 µmol/L. Coronary angiography (CAG) performed on day 5 revealed diffusely spastic coronary arteries with 90% stenosis in the right coronary artery, leading to the diagnosis of VSA in the presence of coronary atherosclerosis. Case 2: A 63-year-old male patient with type 2 diabetes (BMI 22.2 kg/m2) experienced severe chest discomfort and faintness following 2 months of chest pain while on dapagliflozin 10 mg daily for 1 year: plasma glucose, 112 mg/dL; urine ketones, (+++); HCO3-, 15.3 mmol/L; and total ketone body, 10,883 µmol/L. CAG performed on day 10 revealed no organic stenosis but diffusely spastic coronary arteries in response to coronary ergonovine infusion, confirming the diagnosis of VSA. SGLT2i has the potential to inhibit acetylcholine and butyrylcholine esterase activities, leading to reduced scavenging of acetylcholine and possible induction of coronary vasospasm. These cases highlight the association between life-threatening VSA and SGLT2i-induced eDKA.
摘要：
正常血糖糖尿病酮症酸中毒（eDKA）已成为与钠-葡萄糖转运蛋白2抑制剂（SGLT2i）相关的不良事件。我们提供了两例SGLT2i诱导的eDKA的连续病例，均表现为危及生命的冠状动脉血管痉挛型心绞痛（VSA）。病例1：64岁男性超重2型糖尿病患者（BMI28.2kg/m2），达格列净每天5毫克治疗6个月，限制饮食2个月，在开车时经历严重的胸痛后意识丧失，导致交通事故:血浆葡萄糖，163毫克/分升;尿酮,(+++);碳酸氢盐(HCO3-),13.2mmol/L；和总酮体，1539μmol/L第5天进行的冠状动脉造影（CAG）显示弥漫性痉挛的冠状动脉，右冠状动脉狭窄90％，导致在存在冠状动脉粥样硬化的情况下诊断VSA。病例2：一名63岁的男性2型糖尿病患者（BMI22.2kg/m2）在服用达格列净10mg每日1年的2个月胸痛后出现严重的胸部不适和昏厥：血浆葡萄糖，112毫克/分升；尿酮，(+++);HCO3-,15.3mmol/L；和总酮体，10883μmol/L在第10天进行的CAG显示，由于冠状动脉麦角新碱的输注，没有器质性狭窄，而是弥漫性痉挛的冠状动脉。确认VSA的诊断。SGLT2i具有抑制乙酰胆碱和丁酰胆碱酯酶活性的潜力，导致乙酰胆碱的清除减少，并可能诱导冠状血管痉挛。这些病例强调了危及生命的VSA和SGLT2i诱导的eDKA之间的关联。
