度拉糖肽和恩格列净联用致糖尿病酮症酸中毒  

Diabetic ketoacidosis induced by combination use of dulaglutide and empagliflozin

作　　者：赵雪[1] 李凡 张彦丽[1] 张晓 曹俊岭 Zhao Xue;Li Fan;Zhang Yanli;Zhang Xiao;Cao Junling(Department of Pharmacy,East Hospital of Beijing University of Chinese Medicine,Beijing 100078,China;Department of Pharmacy,Beijing Fengtai District Hospital of Traditional Chinese Medicine,Beijing 100076,China)

机构地区：[1]北京中医药大学东方医院药学部,北京100078 [2]北京市丰台区中医医院药学部,北京100076

出　　处：《药物不良反应杂志》2022年第3期147-149,共3页Adverse Drug Reactions Journal

摘　　要：1例41岁女性2型糖尿病患者长期应用二甲双胍、格列美脲、西格列汀和阿卡波糖,因血糖升高调整降糖方案为口服二甲双胍和阿卡波糖,并予度拉糖肽1.5 mg皮下注射、1次/周。每次应用度拉糖肽后患者均出现严重厌食,但可耐受,未干预。第1次注射度拉糖肽3 d后加用恩格列净5 mg、1次/d,次日调整为10 mg、1次/d。第4次注射度拉糖肽次日,患者出现头晕、恶心、呕吐、全身乏力等,实验室检查示血糖20.0 mmol/L、动脉血pH 7.22、尿酮体(+++)、尿糖(++++)。诊断为糖尿病酮症酸中毒(DKA)。考虑应用度拉糖肽后严重厌食导致碳水化合物摄入严重不足,与恩格列净并用导致DKA。停用2药,并予对症治疗5 d,实验室检查:午餐后血糖10.1 mmol/L,尿酮体(+),尿葡萄糖阴性,尿pH 5.5。加用恩格列净(5 mg、1次/d),4 d后血二氧化碳结合力23.2 mmol/L、尿酮体(+++)、尿葡萄糖(++++),尿pH 5.0。患者坚持出院,出院后应用重组甘精胰岛素、阿卡波糖、恩格列净降糖。1个月后随访,患者未再出现DKA相关症状。A 41‑year‑old female patient received long‑term treatment with metformin,glimepiride,sitagliptin,and acarbose for type 2 diabetes mellitus.Due to elevated blood‑glucose,the hypoglycemic regimen was adjusted to metformin,acarbose,and dulaglutide(1.5 mg,subcutaneously injected once a week).After each injection of dulaglutide,the patient had severe anorexia but no intervention was given because that the patient could tolerate.Empagliflozin 10 mg orally once daily were added 3 days after the first injection and then the dose was adjusted to 10 mg next day.The day after the fourth injection,the patient developed dizziness,nausea,vomiting,general fatigue,etc.Laboratory tests showed blood glucose 20 mmol/L,arterial blood pH 7.22,partial pressure of carbon dioxide 22.1 mmHg,bicarbonate concentration 8.8 mmol/L,standard bicarbonate 12 mmol/L,total carbon dioxide content 10 mmol/L,ketone body in urine(+++),and urine sugar(++++).Diabetic ketoacidosis was diagnosed.Considering that severe anorexia after the application of dulaglutide caused serious insufficient carbohydrate intake and then empagliflozin‑induced diabetic ketoacidosis was stimulated,the 2 drugs were discontinued and symptomatic and supportive treatments were given.Five days later,laboratory tests showed post‑lunch blood glucose 10.1 mmol/L,ketone body in urine(+),negative urine sugar,and urine pH 5.5.Empagliflozin 5 mg once daily was added and laboratory tests showed carbon dioxide binding capacity of the blood 23.2 mmol/L,urine ketones(+++),urine sugar(++++),and uric acidity 5.0 four days later.The patient insisted on leaving the hospital.After discharge,she was treated with recombinant insulin glargine,acarbose,and empagliflozin.At 1 month of follow‑up,symptoms of diabetic ketoacidosis did not recur.

关 键 词：钠-葡萄糖转运蛋白2抑制剂 糖尿病酮症酸中毒 药物协同作用 胰高血糖素样肽1 恩格列净 度拉糖肽 

分 类 号：R969[医药卫生—药理学]