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Case Reports
. 2025 Jan-Mar;41(1):193-195.
doi: 10.4103/joacp.joacp_59_24. Epub 2025 Jan 23.

Perioperative euglycemic DKA: The YIN and YANG of sodium-glucose cotransporter 2 inhibitors

Shilpushp Bhosale  1 , Akash Golani  2 , Malini Premkumar Joshi  3 , Atul Prabhakar Kulkarni  4
Affiliations
Case Reports

Perioperative euglycemic DKA: The YIN and YANG of sodium-glucose cotransporter 2 inhibitors

Shilpushp Bhosale et al. J Anaesthesiol Clin Pharmacol. 2025 Jan-Mar.

Abstract

Sodium-glucose cotransporter 2 inhibitors are gaining widespread acceptance in managing diabetic patients due to their favorable cardiac and renal protective effects. However, these drugs can cause a lethal complication described as sodium-glucose cotransporter 2 inhibitor-associated perioperative ketoacidosis (SAPKA) if they are continued until surgery. The FDA recommends stopping these medications at least 4-6 days before surgery to avoid the risk of euglycemic ketoacidosis, which can present a diagnostic challenge for perioperative physicians. We present three patients undergoing colorectal cancer surgeries who on SGLT2 inhibitors developed perioperative SGLT2i-associated perioperative ketoacidosis.

Keywords: Perioperative euglycemic DKA; SAPKA; sodium-glucose cotransporter 2 inhibitors.

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Conflict of interest statement

There are no conflicts of interest.

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