胰腺炎后糖尿病患者与乙格列净相关的糖尿病酮症酸中毒1例报告。

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

World Journal of Clinical Cases Pub Date : 2025-09-26 DOI:10.12998/wjcc.v13.i27.108550

Jiang-Tao Chai, Xin-Hui Li, Zhao-Shun Jiang

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引用次数: 0

摘要

背景：钠-葡萄糖共转运蛋白-2 （SGLT-2）抑制剂可改善糖尿病患者的心血管和肾脏预后，但可能通过胰岛素不依赖型机制诱导糖尿病酮症酸中毒（euDKA）。胰腺炎后糖尿病(PPDM) β细胞功能受损的患者使用这些药物的风险尚不明确。病例总结：一名29岁的PPDM患者在开始使用依托格列净（5mg /天）1周后出现euDKA。入院时，实验室检查显示血酮> 4.5 mmol/L, pH 7.1，葡萄糖10.78 mmol/L。停用SGLT-2抑制剂，胰岛素泵治疗（基础12 U/天，餐前4 U），积极补水（前2天6000 mL）和营养支持，24小时内使酮症和酸中毒正常化。结论：在PPDM中使用SGLT-2抑制剂需要谨慎。胰岛素治疗是预防euDKA的首选方法。

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Euglycemic diabetic ketoacidosis associated with etogliflozin in post-pancreatitis diabetes: A case report.

Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors improve cardiovascular and renal outcomes in diabetes but may induce euglycemic diabetic ketoacidosis (euDKA) via insulin-independent mechanisms. Post-pancreatitis diabetes mellitus (PPDM) patients with impaired β-cell function face undefined risks with these agents.

Case summary: A 29-year-old man with PPDM developed euDKA 1 week after initiating etogliflozin (5 mg/day). On admission, laboratory tests revealed blood ketones > 4.5 mmol/L, pH 7.1, and glucose 10.78 mmol/L. Discontinuation of SGLT-2 inhibitor, insulin pump therapy (basal 12 U/day, premeal bolus 4 U), aggressive hydration (6000 mL first 2 days), and nutritional support normalized ketosis and acidosis within 24 hours.

Conclusion: Caution is warranted with SGLT-2 inhibitors in PPDM. Insulin therapy is preferred to prevent euDKA.

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来源期刊

World Journal of Clinical Cases Medicine-General Medicine

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发文量

3384

期刊介绍： The World Journal of Clinical Cases (WJCC) is a high-quality, peer reviewed, open-access journal. The primary task of WJCC is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of clinical cases. In order to promote productive academic communication, the peer review process for the WJCC is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCC are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in clinical cases.