Ketoacidosis Definition

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Euglycemic Diabetic Ketoacidosis: A Potential Complication Of Treatment With Sodium–glucose Cotransporter 2 Inhibition

OBJECTIVE Sodium–glucose cotransporter 2 (SGLT-2) inhibitors are the most recently approved antihyperglycemic medications. We sought to describe their association with euglycemic diabetic ketoacidosis (euDKA) in hopes that it will enhance recognition of this potentially life-threatening complication. RESEARCH DESIGN AND METHODS Cases identified incidentally are described. RESULTS We identified 13 episodes of SGLT-2 inhibitor–associated euDKA or ketosis in nine individuals, seven with type 1 diabetes and two with type 2 diabetes, from various practices across the U.S. The absence of significant hyperglycemia in these patients delayed recognition of the emergent nature of the problem by patients and providers. CONCLUSIONS SGLT-2 inhibitors seem to be associated with euglycemic DKA and ketosis, perhaps as a consequence of their noninsulin-dependent glucose clearance, hyperglucagonemia, and volume depletion. Patients with type 1 or type 2 diabetes who experience nausea, vomiting, or malaise or develop a metabolic acidosis in the setting of SGLT-2 inhibitor therapy should be promptly evaluated for the presence of urine and/or serum ketones. SGLT-2 inhibitors should only be used with Continue reading >>

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Popular Questions

  1. Renfairewench

    Ketosis Tongue or Thrush?

    Seriously, as I sit and write this I am in tears. I simply am not physically nor mentally capable of handling one more issue, but here I am with one more thing that seemingly is going wrong. I'm at this point where I simply want to give up. And by give up I mean, stop feeding, stop drinking, stop taking my meds. I feel miserable all the time and I'm wishing that I never went and had a revision. I'll bet you don't hear that from many people, but I'm blunt and honest in that I'm sick of complications. I'm so depressed that even my all is bright and beautiful meds are not helping me at all. I had my operation on 8/10, I was back in the OR on 8/12. Then they discovered a leak. I've been NPO ever since. I was supposed to be released on 8/21, but my stomanch sprung a leak and my incision had to be opened up to allow for drainage. I was not released until 8/26. I came home for 3 days and was sent back to the hospital for an infected pic line and a DVT (Blood Clot) in my arm. I was in the hospital for that 4 or 5 days. Then I come home for another 4 days to have my husband discover that my open incision was spewing pus everywhere. Back to the hospital for another 5 days. I just got out Friday. I've been on antibiotics since 8/11 and have develoved a case of VRE thanks to being on Vancomycin and being in the hospital. Nothing to worry about really except that I could infect my family if I am not diligent about washing my hands, using alcohol hand cleaner and putting bleach in the tolie****er each time I pee or poo, oh and wiping down the seat with bleach wipes too.
    My water intake is limited by what I can push in my J tube. Since I have a leak and an active infection I have to limit my drinking to 4 to 8 oz. a day of water a day. I am allowed water or ice chips. Nothing more. No tea, no coffee, no crystal lite, nothing. I've been NPO since Aug. 10. I'm pretty goddamned tired of having nothing to eat. As for eating, I'm on 1400 CC of Osmolite a night delivered directly into my intestines via my stupid J tube.
    So today I have felt like I have fur on my tongue. I thought it was because I had not brushed my teeth. I took a look in the mirror and I am horrified at what I see. My entire tongue is covered in a white thick mucous like substance. Brushing my teeth and tongue did not make it go away either. It's still there. I looked up Thrush and it looks like if you have Thrush that there is significant pain involved, but I don't have any pain. I do feel like I have something stuck in the back of my throat though. I've heard other's talk about Ketosis tongue, but I'm not sure what that really is.
    I know that you are not doctors, but I was wondering what your advice is as to what this could be. I have an appointment with my doctor tomorrow to check my blood levels and to adjust my coumadin and will show him this, but I'd like to get a little advice on what you think this might be.

  2. Redhaired

    I had thrush and there was no pain. I tried the liquid stuff and the lozenges, they were nasty and made me sick to my stomach. Finally one day I was speaking with my hematologist and told him about it and I remember very clearly he said "oh we can do better than that". He gave me a prescription for diflucan and it was gone in something like two days!
    It sounds like you have a bad case of thrush.

  3. Renfairewench

    Is it something you swish with? I'm currently on diflucan via IV. I am not allowed to swallow anything.

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