Reactions Weekly | 2021
Dapaglifozin
Abstract
Hyperglycaemic diabetic ketoacidosis: case report A 61-year-old woman developed hyperglycaemic diabetic ketoacidosis during treatment with dapagliflozin for type 2 diabetes mellitus [time to reaction onset not stated]. The woman presented to the central emergency room with nausea and persistent vomiting. Before 4 days, she underwent shoulder surgery at another hospital, after which she developed unexplained nausea. She received various antiemetics including offlabel therapy with ondansetron; however, significant improvement was not observed. For pain therapy, she was discharged with ibuprofen on postoperative day 2. She had difficulty in eating food and consumed only drinks due to persistent nausea. She was in a reduced general state due to the nausea in normal nutritional condition. The physical examination was only remarkable for a slight pain in the area of the operated shoulder. The laboratory examination performed in the emergency room. The venous blood gas analysis showed decreased pH, bicarbonate level, and increased potassium and glucose level. Creatinine was only minimally increased. Based on laboratory findings, she was initially diagnosed with metabolic acidosis with a large anion gap. Upon further anamnesis, she was found to have type 2 diabetes mellitus for about 15 years, for which she had been receiving metformin and oral dapagliflozin 10 mg/day was added only 5 weeks before the presentation. Thus, based on clinical presentation, laboratory findings and medical history and past medications anamnesis, she was diagnosed with hyperglycaemic diabetic ketoacidosis secondary to dapagliflozin. Dapagliozin was discontinued and the woman’s diabetic therapy was switched to insulin. Consequently, she showed rapid progressive improvement in her symptoms.