Introduction: A significant adverse effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors is euglycaemic ketoacidosis. This is of particular significance for surgeons as the combination of long periods of fasting, surgical stress and reduced insulin dosing in acute surgical patients leaves them at an increased risk for developing euglycemic ketoacidosis. This case series reports the adverse reaction to empagliflozin, canagliflozin and dapagliflozin in four acute surgical patients.
Case Series: Case 1: A 43-year-old female underwent elective total abdominal hysterectomy, bilateralsalpingectomy and incisional hernia repair, on a background of type 2 diabetes mellitus (T2DM) treated with metformin, insulin and empagliflozin. She developed significant euglycaemic ketoacidosis complicated by sepsis and a rectus abdominushaematoma. Case 2: A 70-year-old female with acute cholecystitis on a background of T2DM treated with metformin, insulin and canagliflozin. She developed euglycemic ketoacidosis after a 12-hour fast and 24-hour without her usual insulin. Case 3: A 45-year- old female admitted for cholelithiasis and subsequent cholecystectomy on a background of T2DM treated with metformin and dapagliflozin. She developed euglycemic ketoacidosis day-1 post procedure. Case 4: A 49-year-old female who presented with a right thigh abscess and fever, requiring incision and drainage, on a background of T2DM managed with metformin and dapagliflozin. She developed euglycemic ketoacidosis after an extended period of fasting.
Conclusion: Given the increasing use of SGLT2i and the unique combination of risk factors present for surgical patients, it is important that surgeons are familiar with this condition and able to diagnose and treat it early.