Ertugliflozin
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Euglycaemic diabetic ketoacidosis: case report A 24-year-old woman developed euglycaemic diabetic ketoacidosis during treatment with ertugliflozin for diabetes mellitus (DM). The woman presented with a 3-week history of emesis and abdominal pain, which had worsened 1 day prior. Her medical history was significant for autoimmune thyroiditis, DM (diagnosed 5 months prior) and cobalamin-C deficiency (CblC). At presentation, she had CblC-related seizures, intellectual impairment and pigmentary retinopathy. She had been treated with metformin for DM previously with poor tolerance; hence, her therapy was switched to ertugliflozin [dosage and route not stated] 4 months prior. Thereafter, alogliptin was added to her treatment regimen 1 month following ertugliflozin initiation for persistent hyperglycaemia. At presentation, examination was notable for fatigue, anorexia and a weight loss of 37lb. Laboratory parameters were as follows: CO2 16.0 mmol/L, glucose 138 mg/dL, pH 7.19, bicarbonate 6.1 mmol/L and base excess -20 mmol/L. The acidosis was presumed to be due to CblC-related metabolic decompensation. Further studies revealed the following: homocysteine 125.4 µmol/L, βhydroxybutyrate 11.0 mmol/L, methylmalonic acid 4500 nmol/L and HbA1c 8.2%. The laboratory findings were significant for ketonaemia. Hence, she was diagnosed with ertugliflozin-induced euglycaemic diabetic ketoacidosis. Additionally, CblC, insulin deficiency and dehydration also contributed to the euglycaemic diabetic ketoacidosis. The woman was treated with insulin infusions, later switched to basal bolus insulin. Subsequent laboratory test demonstrated findings significant for autoimmune DM [outcome not stated]. Kamoun C, et al. Euglycemic diabetic ketoacidosis related to SGLT2 inhibitor use in a patient with cobalamin C deficiency and diabetes. Hormone Research in Paediatrics 93 (Suppl. 1): 80-81 (plus poster) abstr. 115, Jul 2020. Available from: URL: http://doi.org/10.1159/000509566 [abstract] 803506280
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Reactions 10 Oct 2020 No. 1825
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