Open AccessSodium–glucose cotransporter 2 inhibitor‐induced euglycaemic diabetic ketoacidosis in heart failure with preserved ejection fraction
Author(s) -
Cavka Luka,
Bencak Ferko Urska,
Pitz Natasa,
Trpkovski Zoranco,
Lainscak Mitja
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13452
Subject(s) - medicine , diabetic ketoacidosis , heart failure , ejection fraction , ketoacidosis , diabetes mellitus , cardiology , heart failure with preserved ejection fraction , type 2 diabetes , intensive care medicine , endocrinology , type 1 diabetes
The number of patients receiving sodium–glucose cotransporter 2 inhibitors (SGLT2is), especially those with heart failure, is increasing worldwide. SGLT2is control glycaemia by triggering glycosuria with simultaneous facilitation of a more ketogenic metabolic profile. Patients therefore are more prone to develop euglycaemic diabetic ketoacidosis (euDKA), an entity largely unknown beyond diabetes care professionals. We present a heart failure with preserved ejection fraction (HFpEF) patient with known Type 2 diabetes. He was treated with dapagliflozin and presented acutely with dyspnoea, hyperglycaemia, and ketoacidosis. After standard treatment for diabetic ketoacidosis, hyperglycaemia was corrected, while metabolic ketoacidosis persisted, and thus, euDKA was suspected. With adequate therapy, the patient recovered completely and was discharged without any sequelae. To the best of our knowledge, our case is the first to describe SGLT2i‐induced euDKA in HFpEF patients. Regarding no previous reports of euDKA in heart failure with reduced ejection fraction, our report is highly relevant for ongoing SGLT2i trials in HFpEF and clinical practice in general.