Ann Pharmacol Pharm | Volume 5, Issue 1 | Case Series | Open Access

Acute Abdominal Pain in a Diabetic Patient Receiving SGLT2i: Is it an Endocrine or Surgical Emergency?

Passarani S1, Bertuzzi F2, Bonomo MA2, Mantovani EMA3, Guarnieri M3, Disoteo OE2, Pintaudi B2 and Pani A4*

1Department of Anesthesia and Resuscitation, Policlinico di Monza, Monza Brianza, Italy
2SSD Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy
3Postgraduate School of Anesthesia and Resuscitation, Milano-Bicocca University, Italy
4Postgraduate School of Pharmacology and Toxicology, University of Milan, Italy

*Correspondance to: Arianna Pani 

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Abstract

Sodium/Glucose Cotransporter-2 Inhibitors (SGLT2i) have been associated with increased risk for ketoacidosis, but it is considered a rare event and its real incidence is still unknown. We here report the case of a severe ketoacidosis (pH 6.9) caused by empagliflozin during an emergency laparoscopic cholecystectomy, to make aware of this drug's adverse effect and to suggest a perioperative management. Clinical features: A 73-years-old man presented at our ER with abdominal pain, nausea, vomiting, and constipation. In his past: a silent myocardial infarction, hypertension, T2DM for 10 years. He was in therapy with empagliflozin 5 mg in association with metformin 1000 mg, insulin glargine 24 UI, bisoprolol 1.25 mg, cardio-aspirin, atorvastatin 40 mg. He introduced empagliflozin one month before the hospital admission. He underwent video-laparoscopic surgery for acute cholecystitis without intraoperative complications. At the end of surgery, since an arterial blood gas analysis showed a marked metabolic acidosis (pH 6.9), the patient was maintained intubated and admitted to the ICU where he was extubated 12 h later, when the blood pH had returned towards normal levels. After diabetological consultation, he was discharged with subcutaneous insulin (Glargine and Lispro) and metformin without empagliflozin. Conclusion: A blood gas analysis is rarely performed in patients with acute abdominal pain, but it is necessary in diabetic patients treated with SGLT2i because euDKA is a severe complication. This case illustrates that an adequate preoperative evaluation of diabetic patients in therapy with these drugs is necessary in order to correctly manage their intake before surgery and to diagnose early a condition of euDKA.

Citation:

Passarani S, Bertuzzi F, Bonomo MA, Mantovani EMA, Guarnieri M, Disoteo OE, et al. Acute Abdominal Pain in a Diabetic Patient Receiving SGLT2i: Is it an Endocrine or Surgical Emergency?. Ann Pharmacol Pharm. 2020;5(1):1174.

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