What question did this study set out to answer?

This research aims to highlight the risks associated with SGLT-2 inhibitors during cardiac surgery, particularly hypernatremia and euglycemic diabetic ketoacidosis (euDKA).

April 27, 2026Open Access

SGLT-2 inhibitor–associated significant hypernatremia and euglycemic diabetic ketoacidosis after cardiac surgery: a case series

Key Points

This research aims to highlight the risks associated with SGLT-2 inhibitors during cardiac surgery, particularly hypernatremia and euglycemic diabetic ketoacidosis (euDKA).
Case series examining patients who underwent cardiac surgery and were on SGLT-2 inhibitors.
Observation of clinical presentations and complications like hypernatremia and euDKA.
Evaluation of the need to discontinue SGLT-2 inhibitors in the perioperative period.
Instances of significant hypernatremia were noted in patients post-surgery.
Cases of euDKA were documented despite normal blood sugar levels, indicating diagnostic challenges.
The findings support the recommendation to discontinue SGLT-2 inhibitors during the perioperative period.

Abstract

SGLT-2 inhibitors induce hypernatremia and euDKA through multiple biological mechanisms, including osmotic diuresis. Because euDKA is characterized by ketoacidosis occurring in the absence of marked hyperglycemia, its diagnosis is often delayed or overlooked. Therefore, it is crucial to recognize the potential risk of these complications when prescribing SGLT-2 inhibitors in the perioperative setting of cardiac surgery. Based on our findings, we recommend discontinuing SGLT-2 inhibitors during the perioperative period.

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