There is growing evidence to support the use of sodium-glucose cotransporter-2 (SGLT2)
inhibitors for type 2 diabetes mellitus (T2DM) and the management of heart failure.
As such, more patients undergoing cardiac surgery are on SGLT2-inhibitor therapy.
Despite the numerous benefits of SGLT2 inhibitors on cardiac health, they can be associated
with an increased risk of diabetic ketoacidosis, often with normal glucose levels
(euglycemic diabetic ketoacidosis or EDKA), which potentially can be detrimental in
this vulnerable patient population. In this narrative review, the authors discuss
17 papers that described EDKA in perioperative cardiac surgical patients. The authors
discuss suggested preventative measures and management options, with a particular
emphasis on raising the clinical awareness of the care teams toward this complication.
SGLT2 inhibitor-induced EDKA is a medical emergency that can be difficult to identify
in the postcardiac surgical patient due to the overlap of signs and symptoms with
other frequent scenarios in these patients. A reduction in SGLT2 inhibitor-associated
EDKA can be mitigated by the appropriate perioperative discontinuation of the medication,
clinical awareness, and early investigation to diagnose the condition, with emphasis
on serum β-hydroxybutyrate. Future quality improvement initiatives are needed to assist
in reducing EDKA in patients taking SGLT2 inhibitors in the perioperative surgical
setting.
Key Words
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Article Info
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Published online: June 15, 2022
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