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Title: Perioperative diabetic ketoacidosis associated with sodium-glucose co-transporter-2 inhibitors: a systematic review
Authors: Thiruvenkatarajan, V
Meyer, EJ
Van Wijk, RM
Jesudason, D
Keywords: diabetic ketoacidosis
hyperglycaemic diabetic ketoacidosis
euglycaemic ketoacidosis
sodium-glucose co-transporter-2 inhibitors
Source: 2019 May 3. pii: S0007-0912(19)30233-8 [Epub ahead of print]
Abstract: BACKGROUND: Perioperative diabetic ketoacidosis (DKA) with near-normal blood glucose concentrations, termed euglycaemic ketoacidosis (EDKA), is an adverse effect associated with sodium-glucose co-transporter-2 inhibitors (SGLT2i). Guidelines are still evolving concerning the perioperative management of patients on SGLT2i. We performed a systematic review of published reports of DKA from SGLT2i in the surgical setting to understand better the clinical presentation and characteristics of SGLT2i-associated DKA. METHODS: We searched PubMed, Embase, and ProQuest for reports of perioperative DKA involving SGLT2i up to January 2019. RESULTS: Forty-two reports of EDKA and five cases of hyperglycaemic diabetic ketoacidosis (HDKA) were identified from 33 publications. Canagliflozin was implicated in 26 cases. Presentation time varied from a few hours up to 6 weeks after operation. Precipitating factors may include diabetes medication changes, diet modifications, and intercurrent illnesses. There were 13 cases (12 EDKA and one HDKA) of bariatric surgery, 10 of them noted very-low-calorie diet regimes as a precipitating factor. No precise association between interruption of SGLT2i and the occurrence of DKA could be identified. Seven patients required mechanical ventilation, and acute kidney injury was noted in five. Five cases needed imaging to rule out anastomotic leak and pulmonary embolism, all of them revealed negative findings. Outcome data were available in 32 cases, all of them recovered completely. CONCLUSIONS: EDKA is likely to be under-recognised because of its atypical presentation and may delay the diagnosis. Understanding this clinical entity, vigilance towards monitoring plasma/capillary ketones helps in early identification and assists in the management.
Description: See also:1) 2)
DOI: 10.1016/j.bja.2019.03.028
PubMed URL:
ISSN: 0007-0912
Journal Title: British Journal of Anaesthesia
Type: Journal Article
Affiliates: Department of Anaesthesia, The Queen Elizabeth Hospital, Adelaide, Australia
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
Study/Trial: Case Control Studies
Appears in Collections:Scholarly and Clinical

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