Canagliflozin-associated diabetic ketoacidosis: a case report

Figures & data

Table 1. Selected laboratory values from patients 1 and 2.

	Time after presentation (hours)
Patient 1	0	3	6.5	10	12
Sodium (mmol/L)	142	146	148	144	142
Potassium (mmol/L)	4.3	4.2	4.5	4	4.6
Chloride (mmol/L)	102	115	119	117	117
Carbon dioxide (mmol/L)	8*	10*	12*	17	17
Anion gap	32*	21*	17*	10	8
BUN (mg/dL)	43	39	34	31	27
Creatinine (mg/dL)	1.92*	1.31*	1.16*	0.98	0.88
Glucose (mg/dL)	366*	287*	–	–	–
Beta hydroxybutyrate (mmol/L)	12.43*		–	–	–
AST (IU/L)	18	12	–	–	–
ALT (IU/L)	27	18	–	–	–
Lipase (U/L)	164*	–	–	–	–
VBG pH	7.09*	–	–	–	–
VBG pCO2 (mmHg)	29*	–	–	–	–
VBG pO2 (mmHg)	44	–	–	–	–
VBG HCO3 (mmol/L)	8.8*	–	–	–	–
VBG tCO2 (mmol/L)	10	–	–	–	–
VBG O2 sat (%)	64	–	–	–	–
	Time after presentation (hours)
Patient 2	0	2.5	5	8	14
Sodium (mmol/L)	137	138	134	134	132
Potassium (mmol/L)	4.7	4.5	4.1	3.9	4.2
Chloride (mmol/L)	102	112	–	111	110
Carbon dioxide (mmol/L)	8*	11*	9*	16	20
Anion gap	27*	15*	–	7	2
BUN (mg/dL)	19	15	12	9	6
Creatinine (mg/dL)	0.76	0.65	0.71	0.62	0.48
Glucose (mg/dL)	327*	249*	334*	235*	103
Beta hydroxybutyrate (mmol/L)	15.35*	–	–	–	–
AST (IU/L)		–	8	–	–
ALT (IU/L)	–	–	8	–	–
Lipase (U/L)	–	–	14	–	–
VBG pH	7.15*	–	7.15*	–	–
VBG pCO2 (mmHg)	29*	–	30*	–	–
VBG pO2 (mmHg)	81	–	65	–	–
VBG HCO3 (mmol/L)	10*	–	10.2*	–	–
VBG tCO2 (mmol/L)	11	–	11	–	–
VBG O2 sat (%)	92	–	86	–	–

Note: * Denotes laboratory values of note. BUN, blood urea nitrogen; AST, aspartate transaminase; ALT, alanine transaminase; VBG, venous blood gas.

Table 2. Physiologic action of sodium–glucose cotransporters.

	Receptor type	Location	Physiologic action	Antagonism	Illustrative xenibiotics
SGLT-1	Sodium/glucose cotransporter	Small intestine, proximal convoluted tubule	Glucose absorption from gut lumen, reabsorption of glucose from renal filtrate	Glucosuria	Sotagliflozin, phlorizin
SGLT-2	Sodium/glucose cotransporter	Small intestine, alpha cells of pancreas, proximal convolute tubule	Glucose absorption from gut lumen, regulation of glucagon secretion from alpha cells, reabsorption of glucose from renal filtrate	Glucosuria, glucagon secretion from alpha cells	Canagliflozin, sotagliflozin, phlorizin
SGLT-3	G-Protein	Hypothalamus	Signals satiety through regulation of GLP-1, GIP, 5HT	Unknown	–

Note: GLP-1: glucagon-like peptide-1; GIP: glucose-dependent insulinotropic peptide; 5HT: serotonin.