SGLT-2 inhibitors like dapagliflozin can cause euglycemic DKA in patients with T2DM and heart failure, especially when exposed to metabolic stressors like PTCA, requiring high clinical suspicion for timely management.
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Heightens peri-PCI caution for euglycemic DKA with SGLT2i; leaves open broader risk as Level 5 evidence.
A 42 year old female with type 2 diabetes mellitus (T2DM), presented with angina on exertion and left ventricular (LV) dysfunction (global LV ejection fraction (EF)=26%). Patient was subjected to coronary angiography which revealed triple vessel disease. Patient was started on usual standard of care heart failure (HF) medications, including sodium-glucose co-transporter-2 (SGLT-2) inhibitor dapagliflozin which is promising new class of drug for treating T2DM and HF. Patient was advised myocardial revascularization in form of percutaneous transluminal coronary angioplasty (PTCA). Post angioplasty patient developed metabolic acidosis (high anion gap with normal lactate and increased ketone levels). Patient was diagnosed as case of euglycemic diabetic ketoacidosis (DKA) and patient was treated by volume resuscitation and insulin infusion.
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Kaur et al. (2021) studied this question.
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