J Neurocrit Care.  2024 Dec;17(2):98-101. 10.18700/jnc.240039.

Diabetic ketoacidosis induced by SGLT2 inhibitors in acute ischemic stroke: a report of two cases

• Jeong JH

• KMID: 2563030
• DOI: http://doi.org/10.18700/jnc.240039

Abstract

Background
Diabetic ketoacidosis (DKA) is a common hyperglycemic emergency characterized by hyperglycemia, metabolic acidosis, and ketonemia. DKA is a rare but serious complication of sodium-glucose cotransporter-2 (SGLT2) inhibitors that requires careful monitoring.
Case Report
We present two cases of acute ischemic stroke in patients who developed DKA during the administration of SGLT2 inhibitors. Case 1 was a 70-year-old woman with a right middle cerebral artery (MCA) infarction who developed severe metabolic acidosis and ketonemia on hospital day 5, which resolved after insulin and fluid therapy. Case 2 was a 52-year-old woman with a right MCA infarction and carotid stenosis who developed DKA on hospital day 3. Despite initial resolution, DKA recurred after SGLT2 inhibitor re-administration and permanent discontinuation was necessary.
Conclusion
These cases highlight the risk of DKA in the acute phase of ischemic stroke in patients treated with SGLT2 inhibitors.

Keyword

Diabetic ketoacidosis; Ischemic stroke; Diabetes; SGLT2 inhibitor

Figure

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  Fig. 1. Changes in the vital signs and key laboratory values during the diabetic ketoacidosis (DKA) episode in case 2. (A) Vital signs were stable, but fever occurred twice prior to the onset of DKA. (B) DKA developed in a patient treated with SGLT2 inhibitors. Following resolution, readministration of the drug led to a subsequent rise in ketone levels. Arrows indicate the timing of SGLT2 inhibitor administration. BST, blood sugar test; MBP, mean blood pressure; HR, heart rate; BT, body temperature; WBC, white blood cell count; CRP, C-reactive protein.

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