The catabolic triad: case report of fasting, major cardiac surgery and sodium-glucose co-transporter 2 inhibitors leading to perioperative euglycaemic ketoacidosis.

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are novel oral hypoglycaemic agents. For patients with diabetes mellitus, without a prior history of myocardial infarction or atherosclerotic disease, SGLT2i have been shown to reduce incident heart failure and worsening renal function. SGLT2i therapy is increasing among patients presenting for cardiac surgery. However, the perioperative use of SGLT2i carries a significant risk of euglycaemic diabetic ketoacidosis, due to their catabolic mechanism of action. This case report demonstrates euglycaemic ketoacidosis post-coronary artery bypass grafting secondary to SGLT2i, highlighting the multiple risk factors and consequences of this iatrogenic complication.

钠 - 葡萄糖协同转运蛋白2抑制剂（SGLT2i）是新型口服降糖药。对于没有心肌梗死或动脉粥样硬化疾病既往史的糖尿病患者，SGLT2i已被证明可降低心力衰竭发生率和肾功能恶化风险。在接受心脏手术的患者中，SGLT2i治疗的应用日益增加。然而，由于其分解代谢的作用机制，SGLT2i在围手术期使用会带来发生正常血糖性糖尿病酮症酸中毒的显著风险。本病例报告展示了冠状动脉旁路移植术后因使用SGLT2i导致的正常血糖性酮症酸中毒，强调了这种医源性并发症的多种风险因素及其后果。