euglycemic diabetic ketoacidosis

糖尿病酮症酸中毒
  • 文章类型: Journal Article
    目的:钠-葡萄糖转运蛋白-2抑制剂(SGLT2i)常用于治疗2型糖尿病,为患有慢性肾病和心力衰竭等非糖尿病患者提供额外的益处。然而,SGLT2i与正常血糖糖尿病酮症酸中毒(DKA)的风险增加有关。本病例系列描述了三例患者在服用SGLT2i时出现正常血糖DKA。主要发现:3例正常血糖DKA患者均服用SGLT2i治疗糖尿病,且均有其他DKA发展的危险因素。这些因素包括口服摄入量减少,重大急性疾病,慢性胰腺炎,以及以前DKA发作的历史。不幸的是,没有高血糖等标志性症状,多尿,和多饮导致3例患者中有2例延迟诊断正常血糖DKA。结论:早期识别危险因素和高度怀疑对于确定服用SGLT2i的患者的正常血糖DKA至关重要。医疗服务提供者应在入院时进行彻底的药物和解,并密切监测患者的并发问题,特别是在口服摄入量最少的情况下,急性疾病,和慢性胰腺炎。及时诊断和管理血糖正常的DKA可以显着改善患者的预后。
    Objectives: Sodium-glucose transporter-2 inhibitors (SGLT2i) are commonly used for the treatment of Type 2 Diabetes Mellitus, offering additional benefits in non-diabetic patients with conditions such as chronic kidney disease and heart failure. However, SGLT2i have been associated with an increased risk of euglycemic diabetic ketoacidosis (DKA). This case series describes three cases of patients who developed euglycemic DKA while taking SGLT2i. Key Findings: Each of the three patients with euglycemic DKA were taking SGLT2i for the treatment of diabetes and all had additional risk factors for the development of DKA. These factors included reduced oral intake, major acute illness, chronic pancreatitis, and a history of previous DKA episodes. Unfortunately, the absence of hallmark symptoms like hyperglycemia, polyuria, and polydipsia led to delayed diagnosis of euglycemic DKA in two of the three patients. Conclusion: Early recognition of risk factors and a high level of suspicion are critical in identifying euglycemic DKA in patients taking SGLT2i. Healthcare providers should conduct thorough medication reconciliation upon admission and closely monitor patients for concurrent issues, especially in cases of minimal oral intake, acute illnesses, and chronic pancreatitis. Prompt diagnosis and management of euglycemic DKA can significantly improve patient outcomes.
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  • 文章类型: Case Reports
    糖尿病酮症酸中毒(DKA)是糖尿病的严重并发症,以高血糖为特征,代谢性酸中毒,和酮症。我们提出了一个具有挑战性的病例,该病例继发于空腹和尿路感染并伴有急性肾功能衰竭的正常血糖DKA。尽管随机血糖水平正常,患者表现出DKA的临床症状,导致进一步调查。确定了高阴离子间隙代谢性酸中毒伴高钾血症和肾功能异常。血液透析后,血清酮被发现是高度阳性的,确认诊断。及时的管理导致了完整的临床和实验室解决方案。该病例强调了在有暗示性症状的患者中考虑DKA的重要性,即使血糖水平正常.
    Diabetic ketoacidosis (DKA) is a severe complication of diabetes mellitus characterized by hyperglycemia, metabolic acidosis, and ketosis. We present a challenging case of euglycemic DKA secondary to fasting and urinary tract infection with acute renal failure in a 50-year-old woman. Despite normal random blood sugar levels, the patient exhibited clinical signs of DKA, leading to further investigation. High anion gap metabolic acidosis with hyperkalemia and abnormal renal function tests were identified. After hemodialysis, serum ketones were found to be highly positive, confirming the diagnosis. Prompt management led to a complete clinical and laboratory resolution. This case underscores the importance of considering DKA in patients with suggestive symptoms, even with normal blood sugar levels.
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  • 文章类型: Case Reports
    钠-葡萄糖协同转运蛋白-2(SGLT2)抑制剂,2型糖尿病(T2DM)管理积分,并非没有风险,报告的不良反应包括正常血糖糖尿病酮症酸中毒(EDKA)。我们介绍了一例75岁女性使用canagliflozin治疗T2DM,出现精神状态改变(AMS)的人,恶心,呕吐,和低血压。实验室结果显示酮症酸中毒,肌钙蛋白升高,和Takotsubo心肌病(TC),促使canagliflozin停止.这个矛盾的EDKA案例强调了谨慎处方的必要性。此外,我们的讨论深入研究了风险因素,机制,与SGLT2抑制剂(SGLT2i)相关的EDKA的流行病学,强调个体化医疗的重要性和使用中的共同决策,尽管它们已被证明对心血管有好处。
    Sodium-glucose co-transporter-2 (SGLT2) inhibitors, integral in type 2 diabetes mellitus (T2DM) management, are not without risks, with reported adverse effects including euglycemic diabetic ketoacidosis (EDKA). We present a case of a 75-year-old female with T2DM on canagliflozin, who developed altered mental status (AMS), nausea, vomiting, and hypotension. The laboratory results revealed ketoacidosis, elevated troponins, and Takotsubo cardiomyopathy (TC), prompting the cessation of canagliflozin. This paradoxical EDKA case underscores the necessity for cautious prescribing. Additionally, our discussion delves into the risk factors, mechanisms, and epidemiology of EDKA associated with SGLT2 inhibitors (SGLT2i), emphasizing the importance of individualized medicine and shared decision-making in their use, despite their proven cardiovascular benefits.
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  • 文章类型: Case Reports
    正常血糖糖尿病酮症酸中毒(EDKA)是一种罕见的糖尿病酮症酸中毒(DKA)亚型,其实验室发现与经典DKA相似,但血糖水平低于250mg/dl。EDKA有几种病因,包括怀孕,饥饿和钠-葡萄糖协同转运蛋白-2抑制剂(SGLT-2)的使用。SGLT-2抑制剂如依帕格列净和达格列净由于它们对糖尿病和心脏病患者的积极益处而越来越受欢迎。EDKA被诊断不足,因为它的血糖水平低于经典DKA的预期。该病例报告描述了一名控制良好的2型糖尿病患者,该患者在接受冠状动脉造影治疗急性心力衰竭后使用SGLT-2抑制剂开发了EDKA。
    Euglycemic diabetic ketoacidosis (EDKA) is an uncommon subtype of diabetic ketoacidosis (DKA) which presents with similar laboratory findings to classic DKA with the exception of blood glucose levels being under 250 mg/dl. EDKA has several etiologies including pregnancy, starvation and the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2). SGLT-2 inhibitors such as empagliflozin and dapagliflozin are increasing in popularity due to their positive benefits for patients with diabetes mellitus and cardiac disease. EDKA is underdiagnosed as it presents with blood sugar levels lower than expected in classic DKA. This case report describes a well-controlled type 2 diabetic patient prescribed an SGLT-2 inhibitor who developed EDKA after undergoing coronary angiography for acute heart failure.
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  • 文章类型: Journal Article
    背景:糖尿病酮症酸中毒(DKA)表现为高血糖,代谢性酸中毒,和酮症。然而,正常血糖DKA(eu-DKA)隐藏血糖水平低于200mg/dL的严重DKA。钠-葡萄糖协同转运蛋白-2(SGLT2)抑制剂可在糖尿病患者中诱导eu-DKA。值得注意的是,2019年冠状病毒病(COVID-19)感染的使用SGLT2抑制剂的糖尿病患者由于病毒对胰岛的直接毒性影响,面临欧盟DKA的风险增加。本研究旨在通过细致的病例报告分析,全面探讨SGLT2抑制剂与eu-DKA在COVID-19患者中的相关性。此外,我们努力检查接受SGLT2抑制剂的COVID-19感染的糖尿病患者的结局和治疗方法,为管理这一特定患者人群的医疗保健专业人员提供不可或缺的见解。
    目的:通过对病例报告的细致分析,探讨SGLT2抑制剂与COVID-19患者正常血糖DKA的关系。
    方法:我们在著名的电子数据库中进行了详尽的搜索,包括PubMed,Scopus,WebofScience,谷歌学者。此次搜索涵盖了2019年12月至2022年5月的期间,纳入了已发表的研究和预印本。使用的搜索术语包括“SGLT2抑制剂”,“正常血糖DKA”,“COVID-19”,和相关的变化。通过整合这些不同的来源,我们的目标是确保对有关此主题的现有文献进行彻底探索,从而增强我们研究结果的有效性和稳健性。
    结果:我们的搜索共产生了7个病例报告和1个病例系列,总共包括12名患者的队列。这些报告了COVID-19患者中欧盟DKA的详细实例。至关重要的是,所有12例患者均使用SGLT2作为其主要的抗糖尿病药物.一被录取,所有口服药物都及时停药,患者开始静脉胰岛素治疗以有效管理DKA.令人鼓舞的是,11名患者表现出良好的结果,遗憾的是,一名病人死于这种情况。随后,所有患者出院后停止SGLT2。这些发现为与COVID-19和SGLT2相关的eu-DKA病例的临床管理和结果提供了有价值的见解,强调了及时干预和警惕药物调整的至关重要性。
    结论:我们的研究揭示了糖尿病患者发生药物相关和无关DKA的可能性,以及在COVID-19的背景下遇到不良结局,尽管血糖控制保持令人满意。COVID-19的血糖控制与临床结局之间的关系仍然不明确。因此,这项系统评价提出,使用SGLT2的COVID-19感染的糖尿病患者应考虑替代治疗方案,直至其疾病康复.
    BACKGROUND: Diabetic ketoacidosis (DKA) manifests as hyperglycemia, metabolic acidosis, and ketosis. However, euglycemic DKA (eu-DKA) conceals severe DKA with glucose levels below 200 mg/dL. Sodium-glucose cotransporter-2 (SGLT2) inhibitors can induce eu-DKA in diabetic patients. Notably, coronavirus disease 2019 (COVID-19) -infected individuals with diabetes using SGLT2 inhibitors face an augmented risk of eu-DKA due to the direct toxic impact of the virus on pancreatic islets. This study aims to comprehensively investigate the association between SGLT2 inhibitors and eu-DKA in COVID-19 patients through meticulous case report analysis. Additionally, we endeavor to examine the outcomes and treatment approaches for COVID-19-infected diabetics receiving SGLT2 inhibitors, providing indispensable insights for healthcare professionals managing this specific patient population.
    OBJECTIVE: To investigate the connection between SGLT2 inhibitors and euglycemic DKA in COVID-19 patients through a meticulous analysis of case reports.
    METHODS: We conducted an exhaustive search across prominent electronic databases, including PubMed, SCOPUS, Web of Science, and Google Scholar. This search encompassed the period from December 2019 to May 2022, incorporating published studies and pre-prints. The search terms employed encompassed \"SGLT2 inhibitors\", \"euglycemic DKA\", \"COVID-19\", and related variations. By incorporating these diverse sources, our objective was to ensure a thorough exploration of the existing literature on this subject, thereby augmenting the validity and robustness of our findings.
    RESULTS: Our search yielded a total of seven case reports and one case series, collectively comprising a cohort of twelve patients. These reports detailed instances of eu-DKA in individuals with COVID-19. Crucially, all twelve patients were utilizing SGLT2 as their primary anti-diabetic medication. Upon admission, all oral medications were promptly discontinued, and the patients were initiated on intravenous insulin therapy to effectively manage the DKA. Encouragingly, eleven patients demonstrated a favorable outcome, while regrettably, one patient succumbed to the condition. Subsequently, SGLT2 were discontinued for all patients upon their discharge from the hospital. These findings provide valuable insights into the clinical management and outcomes of eu-DKA cases associated with COVID-19 and SGLT2, underscoring the critical importance of prompt intervention and vigilant medication adjustments.
    CONCLUSIONS: Our study sheds light on the possibility of diabetic patients developing both drug-related and unrelated DKA, as well as encountering adverse outcomes in the context of COVID-19, despite maintaining satisfactory glycemic control. The relationship between glycemic control and clinical outcomes in COVID-19 remains ambiguous. Consequently, this systematic review proposes that COVID-19-infected diabetic patients using SGLT2 should contemplate alternative treatment protocols until their recovery from the disease.
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  • 文章类型: Journal Article
    在过去的10年中,钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)已用于治疗糖尿病患者。正常血糖糖尿病酮症酸中毒(euDKA)可能是危及糖尿病患者生命的并发症。作者报告了2型糖尿病(T2DM)患者的严重uDKA伴乳酸性酸中毒。本报告强调了早期发现和治疗EuDKA以避免并发症的重要性。
    患有T2DM的44岁女性多次到急诊科就诊,反复腹泻和呕吐。在她第三次访问时,她出现呼吸急促和呼吸急促,发现有严重的代谢性酸中毒,血糖正常。她因SGLT2i继发的euDKA入院ICU,并得到了相应的治疗。
    T2DM中SGLT2i与euDKA之间的关联存在争议。SGLT2i通过在体积耗尽的情况下刺激脂解和生酮作用导致euDKA,碳水化合物缺乏,以及反调节应激激素的上调。EuDKA可能会危及生命,特别是如果没有正确诊断和管理。治疗方案类似于高血糖性糖尿病酮症酸中毒。我们的病例报告符合CARE标准。
    SGLT2i对糖尿病患者的益处大于风险。建议临床医生为患有SGLT2的糖尿病患者提供咨询,并教育他们在急性疾病中服用药物,体积耗尽,减少口服摄入量,和手术。此外,对于在SGLT2i使用背景下出现代谢性酸中毒的患者,应该有较高的怀疑指数,以提供早期诊断和治疗.
    Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been implemented in treating diabetic patients for the past 10 years. Euglycemic diabetic ketoacidosis (euDKA) can be a life-threatening complication in diabetic patients. The authors report a severe euDKA with lactic acidosis in a type 2 diabetes mellitus (T2DM) patient. This report highlights the importance of the early detection and treatment of EuDKA to avoid complications.
    UNASSIGNED: Forty-four-year-old female with T2DM had multiple visits to the emergency department with recurrent diarrhoea and vomiting. On her third visit, she presented with shortness of breath and tachypnoea, found to have severe metabolic acidosis with euglycemia. She was admitted to ICU with euDKA secondary to SGLT2i and was managed accordingly.
    UNASSIGNED: The association between SGLT2i and euDKA in T2DM is controversial. SGLT2i leads to euDKA by stimulating lipolysis and ketogenesis in the setting of volume depletion, carbohydrate deficiency, and upregulation of counter-regulatory stress hormones. EuDKA can be life-threatening, especially if not diagnosed and managed properly. The treatment protocol is similar to hyperglycaemic diabetic ketoacidosis. Our case has been reported in line with the CARE criteria.34.
    UNASSIGNED: SGLT2i benefits in diabetic patients outweigh the risks. Clinicians are advised to counsel diabetic patients maintained on SGLT2 and educate them regarding holding the medication in the setting of acute illness, volume depletion, decreased oral intake, and surgery. In addition, there should be a high index of suspicion for patients presenting with metabolic acidosis in the background of SGLT2i use to provide early diagnosis and management.
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  • 文章类型: Case Reports
    钠-葡萄糖协同转运蛋白-2抑制剂现在被认为是2型糖尿病的二线治疗药物,并提供了一种独特的治疗方法,增加了心肾益处。这类药物会增加正常血糖糖尿病酮症酸中毒的风险,如果临床医生没有意识到危险因素和微妙的症状,这可能很难诊断。本文介绍了一例冠心病患者的正常血糖糖尿病酮症酸中毒,该患者正在服用钠-葡萄糖协同转运蛋白2抑制剂,并在心脏导管插入后立即出现急性精神状态变化。
    Sodium-glucose cotransporter-2 inhibitors are now considered second-line treatment agents for type 2 diabetes and offer a unique treatment approach with added cardiorenal benefits. Drugs in this class increase the risk of euglycemic diabetic ketoacidosis, which may be difficult to diagnose if clinicians are not aware of the risk factors and subtle symptoms. This article describes a case of euglycemic diabetic ketoacidosis in a patient with coronary artery disease who was taking a sodium-glucose cotransporter-2 inhibitor and experienced acute mental status changes immediately after heart catheterization.
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  • 文章类型: Case Reports
    未经证实:糖尿病酮症酸中毒(DKA)是糖尿病最严重的急性并发症之一。其定义特征是高血糖和酮症酸中毒。常血糖DKA(EDKA)影响血清葡萄糖水平在正常范围内的患者。使用钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是这种疾病的新发现的风险之一。
    UNASSIGNED:一名患有2型糖尿病的75岁妇女因意识下降和口服摄入量减少而被送往我们的急诊科,持续两天。她被诊断出脑血管意外已经12天了,依帕利福净被添加到她的药物中。实验室评估显示代谢性酸中毒,尽管血清葡萄糖浓度最低限度地升高。该患者因依帕格列净继发EDKA入院重症监护病房,并接受静脉补液疗法和静脉胰岛素输注治疗。
    UNASSIGNED:Empagliflozin(SGLT2抑制剂)是一种新的抗高血糖药物,与DKA的风险增加有关。几个患者出现正常或最低限度的血清葡萄糖浓度升高,这经常导致诊断延迟。在服用SGLT2抑制剂时评估患有无法解释的代谢性酸中毒的患者时,应考虑EDKA,和SGLT2抑制剂应停用,如果酸中毒被证实。
    UNASSIGNED: Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes. Its defining features are hyperglycemia and ketoacidosis. Euglycemic DKA (EDKA) affects patients whose serum glucose levels are within the normal range. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is one of the newly identified risks for this condition.
    UNASSIGNED: A 75-year-old woman with type 2 diabetes mellitus presented to our emergency department with decreased consciousness and decreased oral intake for two days. She had been diagnosed with a cerebrovascular accident for 12 days, and empagliflozin was added to her medications. Laboratory evaluation revealed metabolic acidosis, despite a minimally elevated serum glucose concentration. The patient was admitted to the intensive care unit with EDKA secondary to empagliflozin and treated with intravenous rehydration therapy and intravenous insulin infusion.
    UNASSIGNED: Empagliflozin (SGLT2 inhibitor) is a new anti-hyperglycemic medication that is associated with an increased risk of DKA. Several patients present with normal or minimally elevated serum glucose concentration, which frequently leads to a delay in diagnosis. EDKA should be considered when evaluating a patient with unexplained metabolic acidosis while taking an SGLT2 inhibitor, and SGLT2 inhibitors should be discontinued if acidosis is confirmed.
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  • 文章类型: Case Reports
    糖尿病酮症酸中毒(DKA)被认为是医疗紧急情况,最常见的与1型糖尿病有关,在2型糖尿病(T2DM)中相对罕见。我们讨论了一例患有T2DM的45岁女性患者,因嗜睡和虚弱而出现在急诊室。在她的演讲之前,她的医生最近添加了empagliflozin,钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂,她的抗糖尿病药物方案以及格列美脲和维格列汀和二甲双胍的联合药物。根据临床检查和实验室检查结果,怀疑是DKA,但她的血糖水平低于DKA诊断的临界值.然而,她的实验室结果显示有显著的代谢性酸中毒和酮症血症,没有败血症的临床或实验室特征.因此,诊断为正常血糖糖尿病酮症酸中毒(eu-DKA).她根据DKA方案成功治疗,并状况良好。在这份报告中,我们的目的是讨论SGLT-2抑制剂与eu-DKA之间的关系。鉴于没有明显的高血糖,临床医生对该实体的认可可能会延迟。有恶心症状的糖尿病患者应获得血清酮,呕吐,或在服用SGLT-2抑制剂时不适,如果证实酮症酸中毒,应停用SGLT-2抑制剂。
    Diabetic ketoacidosis (DKA) is considered a medical emergency, most commonly associated with type 1 diabetes mellitus, and is relatively rare in type 2 diabetes mellitus (T2DM). We discuss a case of a 45-year-old woman with T2DM who presented to the emergency room with worsening lethargy and weakness. Before her presentation, her physician had recently added empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, to her anti-diabetic drug regimen along with glimepiride and a combination drug of vildagliptin and metformin. Based on the clinical examination and lab findings, DKA was suspected, but her glucose level was below the cutoff value for DKA diagnosis. However, her lab results showed significant metabolic acidosis and ketonemia with no clinical or laboratory features of sepsis. Therefore, the diagnosis of euglycemic diabetic ketoacidosis (eu-DKA) was made. She was successfully treated according to the DKA protocol and discharged in good condition. In this report, our aim is to discuss the relationship between SGLT-2 inhibitors with eu-DKA. Given the absence of significant hyperglycemia, recognition of this entity by clinicians may be delayed. Serum ketones should be obtained in diabetic patients with symptoms of nausea, vomiting, or malaise while taking SGLT-2 inhibitors, and SGLT-2 inhibitors should be discontinued if ketoacidosis is confirmed.
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  • 文章类型: Case Reports
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