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Jun, Choe, Woo, Park, Park, Kim, Shim, and Kim: A Case of Diabetic Ketoacidosis Induced by Sodium-Glucose Cotransporter 2 Inhibitor
Case Report

J Korean Diabetes 2015;16(4):310-314.

Published online: 10 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.4.310

A Case of Diabetic Ketoacidosis Induced by Sodium-Glucose Cotransporter 2 Inhibitor

Jae Hyuck Jun, Kyung Jin Choe, Yeong Min Woo, Ye Rim Park, Yoon Kyoo Park, Won Jun Kim, Myoung Sook Shim, Jin Yeob Kim

Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Corresponding author: Won Jun Kim Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung 25440, Korea, E-mail: kozmozman@gnah.co.kr

Received 4 May 2015       Revised 26 May 2015       Accepted 10 June 2015

Copyright © 2015 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of oral antihyperglycemic drugs; inhibition of the cotransporter allows for increased renal glucose excretion that consequently leads to reduced plasma glucose level. We report a rare case of a 73-year-old woman with type 2 diabetes mellitus who developed severe ketoacidosis caused by an SGLT2 inhibitor. At admission, severe ketoacidosis with arterial PH 6.99 was observed, though her serum glucose level of 232 mg/dL was not excessively high. It is necessary to pay attention to patients with type 2 diabetes being treated with an SGLT2 inhibitor, as anorexia, diarrhea, dehydration, and weight loss can develop in conjunction with a high fat/protein diet.

Keywords: Diabetes mellitus, Ketosis, Sodium-glucose cotransporter 2

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Table 1.
Laboratory data at admission
Variable Value
Physical examination
Age (y) 73.0
Height (cm) 150.0
Body mass index (kg/m2) 31.1
Arterial blood gas analysis
pH 7.0
pCO2 (mm Hg) 10.0
pO2 (mm Hg) 192.0
HCO3 (mEq/L) 3.0
3 Base excess (mEq/L) 0.0
Routine complete blood cell
White blood cell (/mm3) 187,00
Hemoglobin (g/dL) 14.2
Platelet (/mm3) 506,000
Blood chemistry
Sodium (mEq/L) 145
Potassium (mEq/L) 4.3
Chloride (mEq/L) 109
Blood urea nitrogen (mg/dL) 29.3
Creatinine (mg/dL) 1.3
Glucose (mg/dL) 232
glycosylated hemoglobin (%) 9
C-peptide (ng/mL) 1.4
Total cholesterol (mg/dL) 149
Triglyceride (mg/dL) 106
High density lipoprotein (mg/dL) 45
Low density lipoprotein (mg/dL) 56
Lactic acid (mg/dL) 20
Ketone 3+
Urinalysis
pH 5
Glucose 2+
Ketone body 3+
Occult blood –
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