Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors
Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglyc...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/11/5/e003666.full |
| _version_ | 1797627943557529600 |
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| author | Rajesh Garg Erica Chow Stephen Clement |
| author_facet | Rajesh Garg Erica Chow Stephen Clement |
| author_sort | Rajesh Garg |
| collection | DOAJ |
| description | Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglycemia seen in diabetic ketoacidosis (DKA). The paper presents a classification system for the severity of EDKA, categorizing it into mild, moderate, and severe based on serum pH and bicarbonate levels. Another classification system is proposed to define stages of EDKA based on anion gap and ketones at the time of diagnosis and during the treatment period. A treatment algorithm is proposed to guide clinicians in managing EDKA. This treatment algorithm includes monitoring anion gap and ketones to guide insulin and fluid management, and slower transition to subcutaneous insulin to prevent a relapse. Increased awareness of EDKA is essential for a timely diagnosis because an early diagnosis and treatment can improve clinical outcomes. |
| first_indexed | 2024-03-11T10:32:33Z |
| format | Article |
| id | doaj.art-55ba4661f8c44f0796844a923876af19 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-03-11T10:32:33Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-55ba4661f8c44f0796844a923876af192023-11-14T14:30:07ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972023-10-0111510.1136/bmjdrc-2023-003666Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitorsRajesh Garg0Erica Chow1Stephen Clement2Division of Endocrinology, Harbor-UCLA Medical Center, Torrance, California, USADivision of Endocrinology, Harbor-UCLA Medical Center, Torrance, California, USADivision of Endocrinology, Inova Fairfax Hospital, Falls Church, Virginia, USAEuglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglycemia seen in diabetic ketoacidosis (DKA). The paper presents a classification system for the severity of EDKA, categorizing it into mild, moderate, and severe based on serum pH and bicarbonate levels. Another classification system is proposed to define stages of EDKA based on anion gap and ketones at the time of diagnosis and during the treatment period. A treatment algorithm is proposed to guide clinicians in managing EDKA. This treatment algorithm includes monitoring anion gap and ketones to guide insulin and fluid management, and slower transition to subcutaneous insulin to prevent a relapse. Increased awareness of EDKA is essential for a timely diagnosis because an early diagnosis and treatment can improve clinical outcomes.https://drc.bmj.com/content/11/5/e003666.full |
| spellingShingle | Rajesh Garg Erica Chow Stephen Clement Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors BMJ Open Diabetes Research & Care |
| title | Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors |
| title_full | Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors |
| title_fullStr | Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors |
| title_full_unstemmed | Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors |
| title_short | Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors |
| title_sort | euglycemic diabetic ketoacidosis in the era of sglt 2 inhibitors |
| url | https://drc.bmj.com/content/11/5/e003666.full |
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