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Euglycemic diabetic ketoacidosis

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https://www.readbyqxmd.com/read/30531609/sodium-glucose-cotransporter-2-inhibitors-an-overview-and-perioperative-implications
#1
Amit Bardia, Mabel Wai, Manuel L Fontes
PURPOSE OF REVIEW: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors. RECENT FINDINGS: Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden...
December 6, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30369948/newer-perspectives-of-mechanisms-for-euglycemic-diabetic-ketoacidosis
#2
Xiaofang Yu, Saifei Zhang, Long Zhang
Euglycemic diabetic ketoacidosis (EDKA) was considered a rare condition with its specific definition and precipitating factors. However, with the wide use of sodium glucose cotransporter 2 (SGLT-2) inhibitors, the newest class of antidiabetic agents, EDKA has come back into the spotlight. Relevant cases are increasingly being reported along with insights into the mechanism of EDKA. It seems increasingly clear that EDKA is more common than we used to believe. The SGLT-2 inhibitor-associated EDKA also indicates a necessary review of our previous understanding of "diabetic" ketoacidosis, since the SGLT-2 inhibitor predisposes patients to DKA in a "starvation" way...
2018: International Journal of Endocrinology
https://www.readbyqxmd.com/read/30364093/euglycemic-diabetic-ketoacidosis-in-the-icu-3-case-reports-and-review-of-literature
#3
Pablo Lucero, Sebastián Chapela
Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus, both type I and type II, as well as other types with diabetes such gestacional diabetes mellitus. It is characterized by blood glucose levels greater than 250 mg/dL and metabolic acidosis (pH < 7.3 and serum bicarbonate < 15 mEq/dL) with an increased anion gap and the presence of ketone bodies in the blood or urine. Within this pathology, there is a subgroup of pathologies which are characterized by being present with no signs of hyperglycemia, posing a diagnostic challenge due to the absence of the main sign of the pathology and the diversity of their pathophysiology...
2018: Case Reports in Critical Care
https://www.readbyqxmd.com/read/30328578/normal-blood-glucose-and-high-blood-ketones-in-a-critically-unwell-patient-with-t1dm-post-bariatric-surgery-a-case-of-euglycemic-diabetic-ketoacidosis
#4
Jemma Dowsett, Rebecca Humphreys, Robert Krones
Obesity is a global epidemic. Obesity in those with type I diabetes (T1DM) contributes to poor glycemic control and complications. Bariatric surgery as management for obesity is increasing in those with T1DM. However, there is limited data pertaining to these patients and their potential post-operative complications. These complications include severe hyperglycemia and diabetic ketoacidosis (DKA). This case study describes a 43-year-old woman with T1DM whose post-operative period following her bariatric surgery was complicated by euglycemic DKA...
October 17, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/30240793/sglt1-inhibition-pros-and-cons
#5
REVIEW
Vasilis Tsimihodimos, Sebastien Filippas-Ntekouan, Moses Elisaf
Sodium Glucose Cotransporters 1 (SGLT1) play important roles in the intestinal absorption of glucose and the renal reabsorption of glucose, especially in patients with uncontrolled diabetes and those receiving SGLT2 inhibitors. As a consequence, the inhibition of SGLT1 transporters may represent an interesting therapeutic option in patients with diabetes. However, genetic models of SGLT1 inactivation indicate that the malfunction of these transporters may have adverse effects on various tissues. In this review, we discuss the available evidence on the beneficial and detrimental effects that the inhibition of SGLT1 transporters might have...
September 18, 2018: European Journal of Pharmacology
https://www.readbyqxmd.com/read/30234515/metabolic-acidosis-in-postsurgical-patient-on-canagliflozin-and-metformin-a-case-report
#6
Ahmed M Darwish
Canagliflozin is a novel drug for diabetes mellitus with the mechanisms of inducing glucosuria through inhibition of the sodium-glucose cotransporter 2 in the kidney independent of insulin activity. We are reporting euglycemic ketoacidosis with severe life-threatening metabolic acidosis. The 2 patients described had type 2 diabetes mellitus and were in a state of relative starvation after abdominal surgery. The first patient had been given an oral diet but was restricted with regard to calorie and sugar intake...
September 18, 2018: A&A practice
https://www.readbyqxmd.com/read/30159178/dapagliflozin-associated-euglycemic-diabetic-ketoacidosis-in-a-patient-presenting-with-acute-pancreatitis
#7
Karun Badwal, Tooba Tariq, Diane Peirce
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a class of medications used for glycemic control in type II diabetes mellitus. Their mechanism of action involves preventing resorption of glucose at the proximal kidney, thereby promoting glucosuria and weight loss. However, they have also been found to be associated with euglycemic diabetic ketoacidosis (euDKA). This case describes a 25-year-old male with a history of type II diabetes on metformin, sitagliptin, and dapagliflozin who was admitted with his third episode of pancreatitis secondary to hypertriglyceridemia...
2018: Case Reports in Endocrinology
https://www.readbyqxmd.com/read/30150107/euglisemic-diabetic-ketoacidotic-coma-caused-by-dapagliflozin
#8
Zeynep Karakaya, Fatih Esad Topal, Firdes Topal, Umut Payza, Pınar Yeşim Akyol
Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening acute complication of diabetes mellitus (DM). Sodium-glucose co-transporter-2(SGLT-2) inhibitors are new orally administered antihyperglycemic agents. These agents are related with rarely seen euglycemic diabetic ketoacidosis (eDKA) cases, which are difficult to diagnose in emergency department (ED) because of absence of an evident hyperglycemia and may result with potentially dangerous outcomes if missed. In this study, we present a clinical case of a patient, admitted to ED with altered mental status after SGLT2 inhibitor dapagliflozin administration...
August 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30047331/ketoacidosis-due-to-empagliflozin-a-paradigm-shift-case-report-and-review-of-literature
#9
Carlos Hernandez-Quiles, Nieves Ramirez-Duque, Domingo Acosta-Delgado
INTRODUCTION: Sodium-glucose cotransporter 2(SGLT2)-inhibitors are new antihyperglycemic agents that have shown a reduction in cardiovascular events in type 2 diabetes mellitus. Recent warnings have been developed about an increased risk of euglycemic and moderate hyperglycemic diabetic ketoacidosis with the use of SGLT2 inhibitors, but its real incidence is not available yet. CASE REPORT: We present a case of DKA with moderate hyperglycemia in a patient treated with metformin and empagliflozin...
July 25, 2018: Current Diabetes Reviews
https://www.readbyqxmd.com/read/30017208/euglycemic-diabetic-ketoacidosis
#10
Alejandro González-Castro, María Ortiz Lasa, Andrés Jiménez Alfonso
No abstract text is available yet for this article.
July 12, 2018: Medicina Clínica
https://www.readbyqxmd.com/read/29941433/euglycemic-diabetic-ketoacidosis-associated-with-the-use-of-a-sodium-glucose-cotransporter-2-inhibitor
#11
Lydia Zhang, Michael Tamilia
No abstract text is available yet for this article.
June 25, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/29923997/euglycemic-diabetic-ketoacidosis-caused-by-dapagliflozin-a-case-report
#12
Yu-Mou Chou, Chen-June Seak, Zhong Ning Leonard Goh, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chih-Chuan Lin
RATIONALE: Diabetic ketoacidosis is a serious and potentially life-threatening acute complication of diabetes mellitus (DM). Euglycemic diabetic ketoacidosis (eDKA) is however challenging to identify in the emergency department (ED) due to absence of marked hyperglycemia, often leading to delayed diagnosis and treatment. eDKA has been recently found to be associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors, one of the newest classes of antidiabetics, though there are very limited reports implicating dapagliflozin as the offending agent in ED patients...
June 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29916741/combined-sglt1-and-sglt2-inhibitors-and-their-role-in-diabetes-care
#13
Thomas Danne, Torben Biester, Olga Kordonouri
The sodium-glucose cotransporter type 1 (SGLT1) is the primary transporter for absorption of glucose and galactose in the gastrointestinal tract. Inhibition blunts and delays postprandial glucose (PPG) excursion. Sodium-glucose cotransporter type 2 (SGLT2) is expressed in the kidney, where it reabsorbs 90% of filtered glucose. Thus, a dual SGLT1 and SGLT2 inhibition (compared with selective SGLT2 inhibition) could result in lower PPG and robust A1c reduction even in patients with reduced kidney function. Sotagliflozin is an oral potent dual inhibitor of the insulin-independent SGLT1 and SGLT2...
June 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29760789/higher-cardiometabolic-risk-in-idiopathic-versus-autoimmune-type-1-diabetes-a-retrospective-analysis
#14
Valentina Guarnotta, Enrica Vigneri, Giuseppe Pillitteri, Alessandro Ciresi, Giuseppe Pizzolanti, Carla Giordano
Background: Idiopathic type 1 diabetes mellitus (IDM) is characterized by an onset with insulinopenia and ketoacidosis with negative β-cell autoimmunity markers and lack of association with HLA. The aim of the study is to compare the clinical and metabolic parameters, the macro and microvascular complications, the adipose tissue dysfunction and the insulin secretion and sensitivity indexes in patients with IDM and autoimmune type 1 diabetes mellitus (ADM) at clinical onset. Methods: Thirty patients with IDM and 30 with ADM, matched for age and gender, were retrospectively analyzed...
2018: Diabetology & Metabolic Syndrome
https://www.readbyqxmd.com/read/29412120/sodium-glucose-cotransporter-2-inhibitors-and-the-risk-of-diabetic-ketoacidosis-from-pathophysiology-to-clinical-practice
#15
Dimitrios Patoulias, Alexandros Manafis, Christos Mitas, Konstantinos Avranas, Georgios Lales, Ioanna Zografou, Christos Sambanis, Asterios Karagiannis
BACKGROUND: SGLT-2 inhibitors are a novel class of antidiabetic drugs, recently approved for the treatment of patients with T2DM. Their cardioprotective and renoprotective action, along with their beneficial effects on metabolic parameters, makes them an attractive therapeutic option. Since 2015, when the US FDA issued warning regarding the increased risk of euDKA in the setting of SGLT-2 inhibitors administration, a vivid discussion upon the direct connection between this novel class and the major metabolic complication of diabetes mellitus is still ongoing...
2018: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/29241389/euglycemic-diabetic-ketoacidosis-associated-with-sodium-glucose-cotransporter-type-2-inhibitors-in-patients-with-type-2-diabetes-mellitus-receiving-oral-therapy
#16
Ryan B Dull, Mikayla L Spangler, Emily L Knezevich, Britney M Lau
INTRODUCTION AND OBJECTIVE: Postmarketing reports and warnings of serious adverse events such as diabetic ketoacidosis (DKA) have raised concern regarding the safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i). This report describes 2 cases of symptomatic SGLT2i-associated euglycemic DKA (euDKA) leading to hospitalization in patients with type 2 diabetes mellitus (DM) previously well controlled on oral medications. CASE REPORTS: Subject 1 is a 55-year-old female admitted with euDKA precipitated by infection and managed with intravenous insulin...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29168157/perioperative-implications-of-sodium-glucose-cotransporter-2-inhibitors-a-case-series-of-euglycemic-diabetic-ketoacidosis-in-three-patients-after-cardiac-surgery
#17
Aaron Lau, Simon Bruce, Erica Wang, Ron Ree, Kevin Rondi, Anthony Chau
PURPOSE: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) comprise the newest class of oral hypoglycemic agents approved for treating type II diabetes mellitus (DM-II). Their use, however, has been associated with the rare development of euglycemic diabetic ketoacidosis (euDKA). We present three cases of euDKA that occurred following elective coronary artery bypass grafting surgery. The role of the anesthesiologist in the prevention, diagnosis, and management of this complication is also discussed...
February 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29157798/euglycemic-diabetic-ketoacidosis-secondary-to-dapagliflozin-use-a-case-report
#18
Felicity Brown, Tamara McColl
BACKGROUND: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a novel class of oral antihyperglycemic agents. They are associated with rare cases of euglycemic diabetic ketoacidosis (DKA), which presents a diagnostic challenge in the emergency department (ED) and potentially severe consequences if missed. CASE REPORT: A 53-year-old man with type 2 diabetes mellitus and a recent Roux-en-Y gastric bypass surgery presented to the ED with nausea, vomiting, and generalized abdominal pain...
January 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29109617/euglycemic-diabetic-ketoacidosis-accompanied-by-severe-hypophosphatemia-during-recovery-in-a-patient-with-type-2-diabetes-being-treated-with-canagliflozin-metformin-combination-therapy
#19
Sonia Shoukat, Nida Arshad Usmani, Oluwakemi Soetan, Faisal Qureshi
No abstract text is available yet for this article.
October 2017: Clinical Diabetes: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29039237/sglt2-inhibitors-are-they-safe
#20
REVIEW
Sebastian Filippas-Ntekouan, Theodosios D Filippatos, Moses S Elisaf
Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics...
January 2018: Postgraduate Medicine
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