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PERIOPERATIVE EUGLYCEMIC DIABETIC KETOACIDOSIS DUE TO SGLT-2 INHIBITORS: A CASE REPORT AND LITERATURE REVIEW
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Abstract
Introduction: Euglycemic diabetic ketoacidosis (euDKA) in perioperative patients using sodium-glucose cotransporter-2 (SGLT-2) inhibitors is a rare but life-threatening complication. This condition presents significant challenges in perioperative management, monitoring, and diagnosis, particularly in emergency surgical settings. Case presentation: A 63-year-old woman with type 2 diabetes mellitus on empagliflozin underwent emergency cholecystectomy for acute calculous cholecystitis. On postoperative day 2, she developed euDKA with parameters: pH: 7.33; PaCO2: 25 mmHg; HCO3-: 13.2 mmol/L; BE: -10.5 mmol/L; Anion gap: 20.2 mmol/L; Serum ketones: 3.46 mmol/L; Blood glucose: 159 mg/dL. The patient received standard treatment, including intravenous insulin, fluid resuscitation, and electrolyte correction. She required intensive care unit admission for five days and was discharged after 12 days of hospitalization. Conclusion: Anesthesiologists should be aware of euDKA in surgical patients using SGLT-2 inhibitors. In emergency surgery: Discontinue SGLT-2 inhibitors upon hospital admission and monitor acid-base balance closely. In elective surgery: Stop SGLT-2 inhibitors at least three days preoperatively to reduce euDKA risk.
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Keywords
SGLT-2 inhibitors, euglycemic diabetic ketoacidosis, perioperative management
References
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