Prescriber beware: report of adverse effect of sodium-glucose cotransporter 2 inhibitor use in a patient with contraindication

摘要

Diabetic ketoacidosis (DKA) is well recognized as an endocrine emergency. Diabetic ketoacidosis more commonly occurs in patients with type I diabetes secondary to the absence of endogenous insulin and their general predilection toward ketone production. Emergency medicine physicians are well trained in the prompt recognition and initiation of appropriate treatment needed to stop the rapidly progressive cycle of acidosis and dehydration before it becomes fatal. Traditionally, diagnostic criteria include hyperglycemia (>350mg/dL), acidosis (serum bicarbonate, <10mEq/L), and presence of elevated circulating ketones (serum and urine) [1]. We present a case of euglycemic DKA in a type 1 diabetic who was taking the recently approved (for use in type II diabetics) sodium-glucose cotransporter 2 inhibitor, canagliflozin (Invokana, Gurabo, Puerto Rico), as both a caution and reminder to emergency medicine physicians that DKA with normal serum glucose levels (acidemia and elevated serum ketones) should be aggressively treated and to ask their type I diabetic patients about off-label use of this or any new class of antidiabetic agents.