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SGLT2-Inhibitor Induced Euglycemic Diabetic Ketoacidosis (EuDKA) - #MEDSHED

Updated: Jan 15

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🥞 SLGT-2 Inhibitor-Induced Euglycemic Diabetic Ketoacidosis (EuDKA) - #MEDSHED

🍐 Sodium-glucose transporter type 2 (SGLT-2) inhibitors are FDA-approved for type 2 diabetes mellitus (T2DM)

🍎 Mechanism: Inhibition of SGLT-2 results in reduced glucose reabsorption in the proximal renal tubules

🌊 SGLT-2 inhibitors have seen increased prescribing from trials having positive outcomes in renal, cardiovascular, and all-cause mortality

🍚 Diabetic ketoacidosis manifests from counterregulatory hormones during acute stress responses in the setting of insulin deficiency

🍖 SGLT-2 inhibiters promote glucosuria (excessive glucose in urine) leading to “normal” serum glucose

🏃 Counterregulatory hormones break down free fatty acids combined with SGLT-2 inhibitor glucosuria results in euglycemic diabetic ketoacidosis (EuDKA)

🎥 Fluid Resuscitation

Crystalloid fluids 1 - 1.5 L within 1st hour

Subsequent fluid selection based on hydration, serum electrolytes, & urinary output

🤖 Insulin Therapy

0.1 unit/kg/hr IV infusion, questionable benefit of IV bolus

Transition with AMS resolution, anion gap closure, PO intake, optimized subq insulin regimen

📋 Electrolytes

Hypokalemia and hypoglycemia are most common (consider potassium-containing fluids)

If BG < 250 mg/dL & anion gap remain elevated, start dextrose-containing fluids for insulin to continue running

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Not medical advice. Educational purposes only. No relationships to report.

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