Euglycaemic ketoacidosis associated with an sglt inhibitor
So, if you're reading this, hopefully you've twigged to the fact that the VBG shows an isolated RAGMA, with ketones on blood glucose.
It's important that if you see this in the exam you understand that this is an increasingly common phenomenon as the SGLT inhibitors are used to treat diabetes.
We've attached a case report below which gives a useful discussion of the subject (although we're not sure about the 5L of fluid they gave..!)
Summarising complex biochemistry, be aware that SGLT-2 inhibitors suppress insulin, which deregulates glucagon transcription and encourages ketotic processes. They also possibly worsen the problem by increasing renal resorption of ketones.
In any event, the mainstay of treatment as for all DKA is insulin (to suppress glucagon production), whilst maintaining fluid, potassium and glycemic homeostasis.
We're very happy to have some discussion via the Facebook page if anyone has any questions.
Article below - happy reading!
It's important that if you see this in the exam you understand that this is an increasingly common phenomenon as the SGLT inhibitors are used to treat diabetes.
We've attached a case report below which gives a useful discussion of the subject (although we're not sure about the 5L of fluid they gave..!)
Summarising complex biochemistry, be aware that SGLT-2 inhibitors suppress insulin, which deregulates glucagon transcription and encourages ketotic processes. They also possibly worsen the problem by increasing renal resorption of ketones.
In any event, the mainstay of treatment as for all DKA is insulin (to suppress glucagon production), whilst maintaining fluid, potassium and glycemic homeostasis.
We're very happy to have some discussion via the Facebook page if anyone has any questions.
Article below - happy reading!
| sglt2_and_dka.pdf |