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. 2015 Sep;6(5):587-90.
doi: 10.1111/jdi.12330. Epub 2015 Feb 20.

Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet

Tomohide Hayami  1 , Yoshiro Kato  1 , Hideki Kamiya  1 , Masaki Kondo  1 , Ena Naito  1 , Yukako Sugiura  1 , Chika Kojima  1 , Sami Sato  1 , Yuichiro Yamada  1 , Rina Kasagi  1 , Toshihito Ando  1 , Saeko Noda  1 , Hiromi Nakai  1 , Eriko Takada  1 , Emi Asano  1 , Mikio Motegi  1 , Atsuko Watarai  2 , Koichi Kato  3 , Jiro Nakamura  1
Affiliations

Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet

Tomohide Hayami et al. J Diabetes Investig. 2015 Sep.

Abstract

We present a case of a 32-year-old diabetic woman with Prader-Willi syndrome who developed severe ketoacidosis caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents, during a strict low-carbohydrate diet. At admission, a serum glucose level of 191 mg/dL was relatively low, though laboratory evaluations showed severe ketoacidosis. This is the first report of ketoacidosis caused by a SGLT2 inhibitor. It is necessary to not only pay attention when using a SGLT2 inhibitor in patients following a low-carbohydrate diet, but also to start a low-carbohydrate diet in patients treated with a SGLT2 inhibitor because of a high risk for developing ketoacidosis.

Keywords: Ketoacidosis; Low-carbohydrate diet; Sodium-glucose cotransporter 2 inhibitor.

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Figures

Figure 1
Figure 1
Clinical course. (a) Clinical course in days 1–3. (b) Clinical course in days 4–11. BW, bodyweight; FPG, fasting plasma glucose; PG, plasma glucose.
See this image and copyright information in PMC

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