Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis

Authors

ŠITINA Michal LUKEŠ Marek ŠRÁMEK Vladimír

Year of publication 2023
Type Article in Periodical
Magazine / Source BMC ENDOCRINE DISORDERS
MU Faculty or unit

Faculty of Medicine

Citation
Web https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-023-01339-w
Doi http://dx.doi.org/10.1186/s12902-023-01339-w
Keywords Empagliflozin; SGLT2 inhibitor; Euglycemic ketoacidosis; Hyperchloremic acidosis; Case report
Description BackgroundEuglycemic diabetic ketoacidosis associated with SGLT2 inhibitors is a rare, relatively new and potentially fatal clinical entity, characterized by metabolic acidosis with normal or only moderately elevated glycemia. The mechanisms are not fully understood but involve increased ketogenesis and complex renal metabolic dysfunction, resulting in both ketoacidosis and hyperchloremic acidosis. We report a rare case of fatal empagliflozin-associated acidosis with profound hyperchloremia and review its pathogenesis.Case presentationA patient with type 2 diabetes mellitus treated with empagliflozin underwent an elective hip replacement surgery. Since day 4 after surgery, he felt generally unwell, leading to cardiac arrest on the day 5. Empagliflozin-associated euglycemic diabetic ketoacidosis with severe hyperchloremic acidosis was identified as the cause of the cardiac arrest.ConclusionsThis unique case documents the possibility of severe SGLT2 inhibitor-associated mixed metabolic acidosis with a predominant hyperchloremic component. Awareness of this possibility and a high index of suspicion are crucial for correct and early diagnosis.

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