Pharmaceutical care for a patient with empagliflozin-induced euglycemic diabetic ketoacidosis

YANG Lili; LI Qi; WANG Hui; GAO Ruilong; MAO Min

doi:10.6039/j.issn.1001-0408.2025.02.14

您当前的位置：

首页 >

文章列表页 >

Pharmaceutical care for a patient with empagliflozin-induced euglycemic diabetic ketoacidosis

更新时间：2025-09-25

- Pharmaceutical care for a patient with empagliflozin-induced euglycemic diabetic ketoacidosis
- ZHONGGUO YAOFANG Vol. 36, Issue 2, Pages: 214-218(2025)
- 作者机构：
  
  1.淄博市中心医院临床药学科，山东淄博　255036
  2.中日友好医院药学部，北京　100029
  3.淄博市中心医院肾内科，山东淄博　255036
  4.河北省玉田县中医医院药学部，河北唐山　064100
  5.中日友好医院心脏科，北京　100029
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.02.14
  CLC： R969.3;R977.1+5
- Received：19 July 2024，
  
  Revised：2024-12-15，
  
  Accepted：30 December 2024，
  
  Published：30 January 2025
- 稿件说明：
移动端阅览
杨立莉,李琦,王辉,等.恩格列净致非高血糖性糖尿病酮症酸中毒患者的药学监护[J].中国药房,2025,36(02):214-218.

YANG Lili,LI Qi,WANG Hui,et al.Pharmaceutical care for a patient with empagliflozin-induced euglycemic diabetic ketoacidosis[J].ZHONGGUO YAOFANG,2025,36(02):214-218.
杨立莉,李琦,王辉,等.恩格列净致非高血糖性糖尿病酮症酸中毒患者的药学监护[J].中国药房,2025,36(02):214-218. DOI： 10.6039/j.issn.1001-0408.2025.02.14.

YANG Lili,LI Qi,WANG Hui,et al.Pharmaceutical care for a patient with empagliflozin-induced euglycemic diabetic ketoacidosis[J].ZHONGGUO YAOFANG,2025,36(02):214-218. DOI： 10.6039/j.issn.1001-0408.2025.02.14.

摘要

目的

为使用恩格列净后出现非高血糖性糖尿病酮症酸中毒（euDKA）的2型糖尿病（T2DM）合并肢带型肌营养不良症（LGMD）患者的药学监护提供参考。

方法

临床药师参与1例服用恩格列净后出现euDKA的T2DM合并LGMD患者的药学监护过程。临床药师结合患者近期服用药物及疾病史，判断患者发生euDKA与恩格列净的关联性为“很可能”。针对euDKA，临床药师建议立即停用恩格列净和二甲双胍，并建议将静脉滴注5%葡萄糖注射液改为静脉滴注10%葡萄糖注射液进行液体复苏，密切监测患者的动脉血气、电解质、血/尿酮体等指标，协助医生判断补液及胰岛素停药时间，和医生协商调整降糖方案，教育患者避免再次使用恩格列净及其他钠-葡萄糖耦联转运体2抑制剂（SGLT2i）。

结果

医生采纳临床药师建议。患者经治疗后病情好转，准予带药出院。

结论

euDKA是SGLT2i较为罕见且严重的不良反应，而LGMD是euDKA的易患人群。临床药师通过评估euDKA与恩格列净的关联性、调整用药方案、开展药学监护等药学服务手段，协助医生制定个体化用药方案，同时对患者进行用药宣教，保障患者用药安全。

Abstract

OBJECTIVE

To provide a reference for the pharmaceutical care of a patient with type 2 diabetes mellitus （T2DM） and limb-girdle muscular dystrophy （LGMD） who developed euglycemic diabetic ketoacidosis （euDKA） after taking empagliflozin.

METHODS

Clinical pharmacists provided pharmaceutical care for a patient with T2DM and LGMD who developed euDKA after taking empagliflozin. According to the patient’s recent use of medications and his conditions， clinical pharmacists assessed the correlation between euDKA and empagliflozin as “very likely”. As to euDKA， clinical pharmacists suggested discontinuing empagliflozin and metformin， and giving intravenous infusion of 10% Glucose injection instead of 5% Glucose injection for fluid resuscitation. Clinical pharmacists monitored the patient’s laboratory indicators such as arterial blood gas analysis， blood/urine ketones and electrolytes. They assisted physicians to decide when to stop intravenous supplements of liquid and insulin. Clinical pharmacists also assisted physicians to adjust the antidiabetic drugs and educated the patient to avoid empagliflozin or other sodium-glucose linked transporter 2 inhibitors （SGLT2i）.

RESULTS

Physicians adopted the suggestions of clinical pharmacists. After treatment， the patient’s condition improved， and he was allowed to be discharged with medication.

CONCLUSIONS

euDKA is a relatively rare and serious adverse reaction associated with SGLT2i， and the patients with LGMD are susceptible to euDKA. Clinical pharmacists assist physicians in developing personalized medication plans by evaluating the association between euDKA and empagliflozin， adjusting medication regimens，conducting pharmaceutical monitoring，and other pharmaceutical services. Meanwhile，they provide medication education to patients to ensure their medication safety.

关键词

Keywords

references

郑淑芬，钟诗龙 . SGLT2抑制剂不良反应信号的挖掘与评价 [J ] . 中国药房， 2021 ， 32 （ 8 ）： 986 - 990 .

ZHENG S F ， ZHONG S L . Excavation and evaluation of ADR signals of SGLT2 inhibitors [J ] . China Pharm ， 2021 ， 32 （ 8 ）： 986 - 990 .

周欣荣，李艳，朱嘉俊，等 . SGLT2抑制剂对2型糖尿病合并心血管疾病患者心血管不良事件影响的Meta分析与试验序贯分析 [J ] . 中国医药导报， 2022 ， 19 （ 8 ）： 64 - 68 .

ZHOU X R ， LI Y ， ZHU J J ， et al . Meta-analysis and trial sequential analysis of the effects of SGLT2 inhibitors on cardiovascular adverse events in type 2 diabetes mellitus patients with cardiovascular disease [J ] . China Med Her ， 2022 ， 19 （ 8 ）： 64 - 68 .

KAZE A D ， ZHUO M ， KIM S C ， et al . Association of SGLT2 inhibitors with cardiovascular，kidney，and safety outcomes among patients with diabetic kidney disease：a meta-analysis [J ] . Cardiovasc Diabetol ， 2022 ， 21 （ 1 ）： 47 .

ATA F ， YOUSAF Z ， KHAN A A ， et al . SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort [J ] . Sci Rep ， 2021 ， 11 （ 1 ）： 10293 .

JUNEJA D ， NASA P ， JAIN R ， et al . Sodium-glucose cotransporter-2 inhibitors induced euglycemic diabetic ketoacidosis：a meta summary of case reports [J ] . World J Diabetes ， 2023 ， 14 （ 8 ）： 1314 - 1322 .

程书平，李明，柳远飞，等 . 非高血糖性糖尿病酮症酸中毒的研究进展 [J ] . 中国急救医学， 2022 ， 42 （ 8 ）： 697 - 700 .

CHENG S P ， LI M ， LIU Y F ， et al . Research progress of euglycemic diabetic ketoacidosis [J ] . Chin J Crit Care Med ， 2022 ， 42 （ 8 ）： 697 - 700 .

STRAUB V ， MURPHY A ， UDD B ， et al . 229th ENMC international workshop：limb-girdle muscular dystrophies：nomenclature and reformed classification Naarden，the Netherlands，17-19 March 2017 [J ] . Neuromuscul Disord ， 2018 ， 28 （ 8 ）： 702 - 710 .

SVART M V ， VOSS T S ， BAYAT M ， et al . Rare presentations of ketoacidosis：diabetic ketoalkalosis and ketoaci-dosis secondary to fasting and muscular dystrophy [J ] . Clin Diabetes ， 2015 ， 33 （ 1 ）： 37 - 39 .

HENDRICKSON A L ， YE X Q ， KALRA S S ， et al . Euglycemic diabetic ketoacidosis in a patient prescribed empagli-flozin and a ketogenic diet：a case of misdiagnosed type 1 diabetes [J ] . Clin Diabetes ， 2021 ， 39 （ 1 ）： 121 - 123 .

NOLAN B J ， VARADARAJAN S ， FOURLANOS S ， et al . Beware ketoacidosis with SGLT2 inhibitors in latent autoimmune diabetes of the adult [J ] . Am J Med ， 2020 ， 133 （ 8 ）： e422 - e424 .

WAN AZMAN S S ， SUKOR N ， ABU SHAMSI M Y ， et al . Case report：high-calorie glucose infusion and tight glycemic control in ameliorating refractory acidosis of empagliflozin-induced euglycemic diabetic ketoacidosis [J ] . Front Endocrinol ， 2022 ， 13 ： 867647 .

PRADHAN P ， LAVALLEE M ， AKINOLA S ， et al . Causality assessment of adverse drug reaction：a narrative review to find the most exhaustive and easy-to-use tool in post-authorization settings [J ] . J Appl Biomed ， 2023 ， 21 （ 2 ）： 59 - 66 .

CHOW E ， CLEMENT S ， GARG R . Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors [J ] . BMJ Open Diabetes Res Care ， 2023 ， 11 （ 5 ）： e003666 .

MUSSO G ， SABA F ， CASSADER M ， et al . Diabetic ke-toacidosis with SGLT2 inhibitors [J ] . BMJ ， 2020 ， 371 ： m4147 .

BRAITHWAITE S S ， LANGE C F ， KLAMUT M . Eug-lycemic diabetic ketoacidosis in Duchenne’s muscular dystrophy [J ] . Diabetes Care ， 1987 ， 10 （ 4 ）： 540 - 541 .

LEE S H ， PARK J H ， HONG M K ， et al . True euglycemic diabetic ketoacidosis in a person with type 2 diabetes and Duchenne muscular dystrophy [J ] . Diabetes Res Clin Pract ， 2011 ， 92 （ 1 ）： e7 - e8 .

DORIS T E ， BOWRON A ， ARMSTRONG A ， et al . Ke-toacidosis in Duchenne muscular dystrophy：a report on 4 cases [J ] . Neuromuscul Disord ， 2018 ， 28 （ 8 ）： 665 - 670 .

罗苏珊，卢家红 . 肢带型肌营养不良 [J ] . 中华神经科杂志， 2019 ， 52 （ 7 ）： 573 - 581 .

LUO S S ， LU J H . Limb-girdle muscular dystrophy [J ] . Chin J Neurol ， 2019 ， 52 （ 7 ）： 573 - 581 .

PETERSEN C ， GYABAAH F ， SOTELO J ， et al . A case of prolonged recovery for post-percutaneous coronary intervention（PCI）sodium-glucose cotransporter-2（SGLT2）inhibitor-induced euglycemic diabetic ketoacidosis in a 28-year-old [J ] . Cureus ， 2023 ， 15 （ 9 ）： e45180 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Pharmaceutical care for the HIV-negative patient with disseminated Talaromyces marneffei osteomyelitis complicated by pulmonary tuberculosis

Expert consensus on rational medication management of targeted PI3K/Akt/mTOR inhibitors in breast cancer

Individualized treatment and pharmaceutical care for breast cancer complicated with chronic kidney disease

Pharmaceutical care of anti-infective treatment for a case of pulmonary infection due to Alternaria alternata after renal transplantation

Anticoagulation therapy analysis and pharmaceutical care for a breast cancer patient with pulmonary thromboembolism accompanied by multiple comorbidities

Related Author

ZHANG Qinghua

HE Liting

Writing Group of Expert Consensus on Rational Medication Management of Targeted PI3K/Akt/mTOR Inhibitors in Breast Cancer

任天舒

赵庆春

ZHANG Ming

YU Lu

WU Xudong

Related Institution

Dept. of Pharmacy， Jiangmen Central Hospital

Dept. of Internal Medicine， Zhonggongmiao Community Hospital of Ningbo Yinzhou District No.2 Hospital Medical Community

Dept. of Clinical Pharmacy， Ningbo Yinzhou District No.2 Hospital

Dept. of Pharmacy， Tangshan Maternal and Child Health Hospital

Dept. of Pharmacy， Tianjin Anding Hospital

⁰