Early detection of euglycemic ketoacidosis during thoracic surgery associated with empagliflozin in a patient with type 2 diabetes: A case report,Journal of Diabetes Investigation

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Early detection of euglycemic ketoacidosis during thoracic surgery associated with empagliflozin in a patient with type 2 diabetes: A case report
Journal of Diabetes Investigation ( IF 3.1 ) Pub Date : 2020-07-19 , DOI: 10.1111/jdi.13365
Chie Kitahara ₁ , Shuhei Morita ₁ , Shohei Kishimoto ₁ , Shohei Matsuno ₁ , Shinsuke Uraki ₁ , Ken Takeshima ₁ , Yasushi Furukawa ₁ , Hidefumi Inaba ₁ , Hiroshi Iwakura ₁ , Hiroyuki Ariyasu ₁ , Hiroto Furuta ₁ , Masahiro Nishi ₁ , Takashi Akamizu _{1,

2}

Affiliation

We report the first case of intraoperatively detected euglycemic diabetic ketoacidosis (DKA) associated with sodium–glucose cotransporter 2 inhibitors during thoracic surgery. A 59‐year‐old man had a 12‐year history of type 2 diabetes mellitus treated with insulin and empagliflozin. The patient developed bacterial empyema and was initiated with antibiotics at a local hospital. Owing to the persistence of his symptoms, he was transferred to our hospital after the medication of empagliflozin the day before surgery. After overnight fasting, the patient underwent thoracoscopic debridement and intrathoracic lavage surgery. During this surgery, he was noted to have euglycemic ketosis and acidosis, and diagnosed as euglycemic DKA. Immediately after the consultation in our department, the patient underwent treatment for DKA. He awoke from anesthesia normally and showed no symptoms of DKA. DKA gradually resolved over the next 24 h. Early identification and management are critical for rapid recovery from perioperative euglycemic DKA associated with sodium–glucose cotransporter 2 inhibitors, especially during thoracic surgery.

中文翻译：

2 型糖尿病患者在胸科手术中与恩格列净相关的正常血糖酮症酸中毒的早期发现：病例报告

我们报告了第一例在胸外科手术期间检测到与钠-葡萄糖协同转运蛋白 2 抑制剂相关的血糖正常的糖尿病酮症酸中毒 (DKA) 病例。一名 59 岁的男性有 12 年的 2 型糖尿病病史，接受过胰岛素和恩格列净治疗。患者出现细菌性脓胸，并在当地医院开始使用抗生素。因症状持续，术前一天服用依格列净后转入我院。隔夜禁食后，患者接受了胸腔镜清创和胸腔内灌洗手术。在这次手术中，他被注意到患有血糖正常的酮症和酸中毒，并被诊断为血糖正常的 DKA。在我科会诊后，患者立即接受了 DKA 治疗。他从麻醉中正常醒来，没有表现出 DKA 症状。DKA 在接下来的 24 小时内逐渐消退。早期识别和管理对于从与钠 - 葡萄糖协同转运蛋白 2 抑制剂相关的围手术期正常血糖 DKA 中快速恢复至关重要，尤其是在胸外科手术期间。

更新日期：2020-07-19

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