Empagliflozin-Induced Acute Pancreatitis and Euglycemic Diabetic Ketoacidosis in Type 2 Diabetes Mellitus

Authors

  • Yasser Sadawey Department of Medicine, Mediclinic ME, Al Jowhara Hospital, AL Ain, UAE https://orcid.org/0000-0002-4254-7683
  • Hesham Metwally Department of Radiology, Mediclinic ME, Al Jowhara Hospital, AL Ain, UAE

DOI:

https://doi.org/10.54536/ajcp.v1i2.747

Keywords:

Diabetic Ketoacidosis, Euglycemic DKA, Sodium-Glucose Cotransporter-2, Empagliflozin, Type 2 diabetes mellitus, Pancreatitis

Abstract

Acute pancreatitis and euglycemic DKA, EDKA, are uncommon but potentially fatal complications in diabetic patients on sodium-glucose cotransporter 2 inhibitors (SGLT2). This case report presents the exceptional occurrence of a 49-year-old; male patient diagnosed with empagliflozin-induced EDKA coupled with T2DM as a precursor to acute pancreatitis. Euglycemic DKA may be produced after administering just one dose of SGLT2. On discharge, empagliflozin was managed to stop. Since the initial administration of SGLT2, this diagnosis should be considered a potential consequence. Appropriate medical treatment is made possible by diagnosing and treating this life-threatening condition promptly.

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References

Blau, J. E., Tella, S. H., Taylor, S. I., & Rother, K. I. (2017). Ketoacidosis associated with SGLT2 inhibitor treatment: analysis of FAERS data. Diabetes/metabolism research and reviews, 33(8), e2924.

Calçada, M. B., Fernandes, L., Soares Costa, R., Montezinho, S., Martins Duarte, F., Frutuoso, L., & Freitas, A. R. (2021). Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis. Clinics and Practice, 11(2), 216-218.

Candelario, N., & Wykretowicz, J. (2016). The DKA that wasn’t: a case of euglycemic diabetic ketoacidosis due to empagliflozin. Oxford medical case reports, 7, 144-146.

Da Silva, P. N., da Conceição, R. A., do Couto Maia, R., & de Castro Barbosa, M. L. (2018). Sodium–glucose cotransporter 2 (SGLT-2) inhibitors: a new antidiabetic drug class. Medchemcomm, 9(8), 1273-1281.

Do, W. Y. C. (n.d.). FDA Issues Multiple Warnings For Newest Class of Diabetes Drugs.

Goldenberg, R. M., Berard, L. D., Cheng, A. Y., Gilbert, J. D., Verma, S., Woo, V. C., & Yale, J.-F. (2016). SGLT2 inhibitor–associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. Clinical therapeutics, 38(12), 2654-2664. e2651.

Jensen, M. L., Persson, F., Andersen, G. S., Ridderstråle, M., Nolan, J. J., Carstensen, B., & Jørgensen, M. E. (2017). Incidence of ketoacidosis in the Danish type 2 diabetes population before and after introduction of sodium–glucose cotransporter 2 inhibitors—a nationwide, retrospective cohort study, 1995–2014. Diabetes care, 40(5), e57-e58.

Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes care, 32(7), 1335-1343.

Munro, J., Campbell, I., McCuish, A., & Duncan, L. (1973). Euglycaemic diabetic ketoacidosis. Br Med. J., 2(5866), 578-580.

Nyenwe, E. A., & Kitabchi, A. E. (2016). The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism, 65(4), 507-521.

Peters, A. L., Buschur, E. O., Buse, J. B., Cohan, P., Diner, J. C., & Hirsch, I. B. (2015). Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium–glucose cotransporter 2 inhibition. Diabetes care, 38(9), 1687-1693.

Pfützner, A., Klonoff, D., Heinemann, L., Ejskjaer, N., & Pickup, J. (2017). Euglycemic ketosis in patients with type 2 diabetes on SGLT2-inhibitor therapy—an emerging problem and solutions offered by diabetes technology. Endocrine, 56(1), 212-216.

Rosenstock, J, F. E. (2015). Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, and Preventable Safety Concern With SGLT2 Inhibitors. Diabetes care, 38(9), 1638-1642. https://doi.org/ doi: 10.2337/dc15-1380.

Sampani, E., Sarafidis, P., & Papagianni, A. (2020). Euglycaemic diabetic ketoacidosis as a complication of SGLT-2 inhibitors: epidemiology, pathophysiology, and treatment. Expert Opinion on Drug Safety, 19(6), 673-682.

Sarafidis, P., Ferro, C. J., Morales, E., Ortiz, A., Malyszko, J., Hojs, R., Khazim, K., Ekart, R., Valdivielso, J., & Fouque, D. (2019). SGLT-2 inhibitors and GLP-1 receptor agonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease. A consensus statement by the EURECA-m and the DIABESITY working groups of the ERA-EDTA. Nephrology Dialysis Transplantation, 34(2), 208-230.

Somagutta, M. R., Agadi, K., Hange, N., Jain, M. S., Batti, E., Emuze, B. O., Amos-Arowoshegbe, E. O., Popescu, S., Hanan, S., & Kumar, V. R. (2021). Euglycemic diabetic ketoacidosis and sodium-glucose cotransporter-2 inhibitors: a focused review of pathophysiology, risk factors, and triggers. Cureus, 13(3).

Taylor, S. I., Blau, J. E., & Rother, K. I. (2015). SGLT2 inhibitors may predispose to ketoacidosis. The Journal of Clinical Endocrinology & Metabolism, 100(8), 2849-2852.

Wibawa, K., Kuhuwael, F. V., Putra, C. R. J., Widiastuti, S. U., & Suciadi, L. P. (2021). Euglycemic diabetic ketoacidosis associated with empagliflozin in patients hospitalized with acute pulmonary embolism. Clinical Diabetology, 10(2), 204-208.

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Published

2022-10-23

How to Cite

Yasser, S., & Hesham, M. (2022). Empagliflozin-Induced Acute Pancreatitis and Euglycemic Diabetic Ketoacidosis in Type 2 Diabetes Mellitus. American Journal of Chemistry and Pharmacy, 1(2), 1–4. https://doi.org/10.54536/ajcp.v1i2.747