目的:确定与正常血糖糖尿病酮症酸中毒(eDKA)发展相关的临床特征和因素,并制定适当的策略来减少此类事件。
方法:提取了2013年12月1日至2021年3月30日之间的电子健康记录(EHR)数据,以识别所有接受外科手术并在这些手术前服用钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)的患者。最终的列表被简化为一部分患有糖尿病酮症酸中毒(DKA)的患者被列为医院诊断,术后血清碳酸氢盐≤16mmol/L,或术后血清pH≤7.20。回顾了临床文件和实验室数据以确定eDKA患者。
结果:总共对1307名患者进行了2183次手术,符合纳入标准,其中大部分(1726例,79.1%)为非急诊患者.在1307名患者中,625例(47.8%)被处方为依帕列净,447(34.2%)卡格列净,214(16.4%)达格列净,和21名(1.6%)ertugliflozin,分别。共有8例与eDKA有关的病例为8例;5例接受了紧急手术,而3例接受了非紧急手术。在3例非紧急情况下,只有1例患者在手术前3天接受了停止SGLT2i的咨询.在接受SGLT2i治疗超过6年的围手术期患者中,非紧急和紧急手术的eDKA发生率为0.17%和1.1%,分别。
结论:优糖DKA在接受非紧急手术的患者中很少见,可能是因为术前指示在手术前3天停止他们的SGLT2i。当SGLT2i不能预防性停止时,接受急诊手术的患者更有可能发生血糖DKA。
OBJECTIVE: To identify clinical characteristics and factors associated with the development of euglycemic diabetic ketoacidosis (eDKA), and develop suitable strategies to reduce such events.
METHODS: Electronic health record (EHR) data were extracted to identify all patients between December 1, 2013, and March 30, 2021, who underwent surgical procedures and had been prescribed a sodium-glucose cotransporter 2 inhibitor (SGLT2i) before these procedures. The resulting list was streamlined to a subset of patients who either had diabetic ketoacidosis (DKA) listed as a hospital diagnosis, postoperative serum bicarbonate ≤ 16 mmol/L, or postoperative serum pH ≤ 7.20. Clinical documentation and laboratory data were reviewed to determine the patients with eDKA.
RESULTS: A total of 2183 procedures conducted on 1307 patients, met the inclusion criteria with the majority (1726, 79.1%) being nonemergent patients. Among 1307 patients, 625 (47.8%) were prescribed empagliflozin, 447 (34.2%) canagliflozin, 214 (16.4%) dapagliflozin, and 21 (1.6%) ertugliflozin, respectively. A total of 8 incidences pertaining to eDKA were noted for 8 unique patients; 5 had undergone emergency surgery whereas 3 had undergone nonemergent procedures. In the 3 nonemergent cases, only 1 patient had received counseling to stop the SGLT2i 3 days before the procedure. In perioperative patients who were prescribed an SGLT2i over 6 years, the incidence of eDKA was 0.17% and 1.1% for nonemergent and emergent procedures, respectively.
CONCLUSIONS: Euglycemic DKA was rare in patients undergoing nonemergent procedures, likely because of preoperative instructions to stop their SGLT2i 3 days before the procedure. Euglycemic DKA was more likely to occur in patients undergoing emergency surgery when the SGLT2i could not be prophylactically stopped.