达格列净致糖尿病心脏手术围手术期患者非高血糖性酮症酸中毒  

Euglycemic diabetic ketoacidosis caused by dapagliflozin in patient with diabetes mellitus during perioperative period of cardiac surgery

作　　者：杨海鹏[1] 陈爽[1] 赵唯炜[1] 赵丽玲 谢若函 李君霞[1] Yang Haipeng;Chen Shuang;Zhao Weiwei;Zhao Liling;Xie Ruohan;Li Junxia(Department of Pharmacy,Henan Provincial Chest Hospital/Chest Hospital of Zhengzhou University,Zhengzhou 450100,China)

机构地区：[1]河南省胸科医院(郑州大学附属胸科医院)药学部,郑州450100

出　　处：《药物不良反应杂志》2023年第4期248-250,共3页Adverse Drug Reactions Journal

摘　　要：1例43岁男性2型糖尿病患者因冠状动脉粥样硬化性心脏病行非体外循环下冠状动脉旁路移植术。术前24 h停用达格列净,术前1 d晚8:00禁食和停用口服药物。手术当日行体外循环前血气分析各项指标及血糖均正常。术后7 h拔除气管插管。手术次日葡萄糖11.2 mmol/L,阴离子间隙13 mmol/L,恢复术前降糖、降压和调脂药物治疗,恢复正常饮食。术后第3天早晨,患者出现呼吸浅快、纳差、尿多、烦躁等症状,血气分析示pH 7.08,动脉血二氧化碳分压(PaCO_(2))11 mmHg(1 mmHg=0.133 kPa),碱剩余-24.5 mmol/L,实际碳酸氢根3 mmol/L;葡萄糖10.4 mmol/L,钾离子5.3 mmol/L;尿常规示酮体(+++)。经补液、纠正电解质及酸碱平衡和胰岛素治疗,10 h后复查血气分析pH 7.44,PaCO_(2)32 mmHg,碱剩余-2.5 mmol/L,实际碳酸氢根21.7 mmol/L,阴离子间隙12 mmol/L;葡萄糖6.7 mmol/L;尿常规示酮体(++)。术后第4天患者症状逐渐好转,应用二甲双胍、阿卡波糖和胰岛素注射液进行血糖管理,因考虑患者酮症酸中毒与达格列净相关,停用该药。术后第15天降血糖方案调整为二甲双胍0.85 g口服、2次/d,阿卡波糖50 mg口服、2次/d,格列美脲2 mg口服、2次/d。此后,患者空腹血糖维持在8.2~10.6 mmol/L,餐后血糖维持在8.2~13.1 mmol/L,糖化血红蛋白7.3%,未再出现酮症酸中毒。A 43‐year‐old male patient with type 2 diabetes mellitus underwent off‐pump coronary artery bypass grafting due to coronary atherosclerotic heart disease.Dapagliflozin was stopped 24 hours before the operation,fasting and discontinuing oral medication started at 8:00 pm 1 day before the operation.On the day of surgery,blood gas analysis and blood glucose were normal before undergoing cardiopulmonary bypass.Tracheal intubation was successfully removed 7 hours after operation.Blood glucose and anion gap were 11.2 mmol/L and 13 mmol/L,respectively on the 2nd day after operation.The treatments of hypoglycemic,antihypertensive and lipid‐regulating drugs and normal diet were restored.On the morning of the 3rd day after operation,the patient developed symptoms such as shallow rapid breathing,poor appetite,excessive urine,and irritability.Blood gas analysis showed pH 7.05,arterial partial pressure of carbon dioxide(PaCO_(2))11 mmHg,base excess-24.5 mmol/L,actual bicarbonate 21.7 mmol/L;blood glucose 10.4 mmol/L,potassium 5.3 mmol/L,and routine urine test showed ketone body(+++)in urine.Treatments such as fluid replacement,electrolyte correction,and acid‐base balance,and insulin therapy were given.Ten hours later,the blood gas analysis showed pH 7.44,PaCO_(2)32 mmHg,alkali residual-2.5 mmol/L,actual bicarbonate 21.7 mmol/L,anion gap 12 mmol/L,blood glucose was 6.7 mmol/L,and routine urine test showed ketone body(++)in urine.The patient′s symptoms were gradually improved on the 4th day after the operation and then metformin,acarbose,and insulin injection were given for blood glucose management.It was considered that the patient had ketoacidosis,which might be associated with dapagliflozin.Then the hypoglycemic regimen was adjusted to oral metformin 0.85 g twice daily,acarbose 50 mg twice daily,and glimepiride 2 mg twice daily on the 15th day after operation.After that,the fasting blood glucose in the patient was maintained at 8.2-10.6 mmol/L,the postprandial blood glucose was maintained at 8.2-13.1 mmol/L,and t

关 键 词：糖尿病 2型 围手术期 钠‐葡萄糖协同转运蛋白2抑制剂 糖尿病酮症酸中毒 达格列净 

分 类 号：R587.2[医药卫生—内分泌] R654.2[医药卫生—内科学]