Sign In
CPSI Share                                                                      
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ ​​
Back to Search
Publication Type: Medication Safety Notice
Single or Multiple Incident: Multiple
Date: 5/1/2018 12:00:00 AM
Country: Australia
The purpose of this safety notice is to raise awareness of the potential occurrence of severe euglycaemic ketoacidosis associated with the use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) in the perioperative period. SGLT2is are oral medications that promote glucose excretion in the urine for the treatment of type 2 diabetes. The notice provides information on the risk of severe diabetic ketoacidosis (DKA) despite near normal or mildly elevated glucose levels. It identifies that SGLT2i may reduce urinary ketone excretion, making urine ketone testing unreliable; blood ketone testing is required. Recommendations to prevent DKA in patients on SGLT2is are provided.

Additional Details

Medication/Gas/Fluid:
oral hypoglycemics, sodium-glucose co-transporter-2 inhibitors (SGLT2i), dapagliflozin (Forxiga®), dapagliflozin + metformin (Xigduo XR®), empagliflozin (Jardiance®), empagliflozin + metformin (Jardiamet®), empagliflozin + linagliptin (Glyxambi®)
Medication/IV List:
hypoglycemics, oral

Rules / Policies / Procedures
  1. Diabetic ketoacidosis should be considered in patients taking SGLT2i who become unwell, including developing abdominal pain, nausea, vomiting, fatigue or unexplained acidosis; a normal plasma glucose level does not exclude the diagnosis.
  2. Blood ketones should be checked in any patient on an SGLT2i who becomes unwell in the perioperative setting, even if the SGLT2i was ceased pre operatively.
  3. Review and update perioperative procedures to alert staff to the risk of diabetic ketoacidosis and to the management of SGLT2i in the perioperative period including recommendations to cease SGLT2i three days prior to surgery.
Training
  1. Be aware of the risk of euglycaemic ketoacidosis associated with the use of SGLT2i in the perioperative period.

Severe euglycaemic ketoacidosis with sodium-glucose co-transporter-2 inhibitors (SGLT2i) in the perioperative period