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ABSTRACT
Background
Euglycemic diabetic ketoacidosis (DKA) is a potentially life-threatening adverse condition
associated with sodium–glucose cotransporter–2 inhibitors (SGLT2i). This risk is further
pronounced in the perioperative period. There is no consensus for when SGLT2i should
be held preoperatively, and recommendations from various organizations have evolved
from 1 day to 3-4 days in the latest American Diabetes Association guidelines. Further
study of patients with perioperative euglycemic DKA is required to help clarify the
optimal timing of preoperative discontinuation of SGLT2i agents.
Methods
This retrospective, single-centre case series examined four patients who developed
postoperative euglycemic DKA after coronary artery bypass grafting, three of whom
underwent semi-urgent surgeries. We characterized their clinical course, predisposing
factors, and treatment characteristics.
Results
The SGLT2i were held for 1 to 5 days preoperatively, with times since last dose before
surgery being 54 hours, 79 hours, 80 hours, and 151 hours. The surgeries were semi-urgent
for three patients, and elective for one patient. Three patients were diagnosed with
euglycemic DKA within 24 hours after surgery. The fourth patient developed euglycemic
DKA on postoperative day 3 in the context of significant hypovolemia and exhibited
potential signs of protracted SGLT2i action at 7 days since the last dose.
Conclusions
The duration of SGLT2i action and risk for DKA is variable and complex. Providers
should hold SGLT2i at least 3 days before elective major surgery, with potentially
longer times in high-risk patients. Careful vigilance should be employed for perioperative
DKA development in all patients recently exposed to SGLT2i.
Key Words
Abbreviations:
CABG (coronary artery bypass grafting), CSICU (cardiac surgery intensive care unit), DKA (diabetic ketoacidosis), NSTEMI (non–ST segment elevation myocardial infarction), PO (oral), POD (postoperative day), PONV (postoperative nausea/vomiting), SC (subcutaneous), SGLT2i (sodium-glucose cotransporter-2 inhibitors), STEMI (ST segment elevation myocardial infarction), T2DM (type 2 diabetes mellitus)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
June 15,
2022
Received in revised form:
May 6,
2022
Received:
April 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
