SGLT2 Inhibitors and Peri-Op Ketoacidosis

SGLT2 Inhibitors are increasingly promoted for diabetes and this article again highlights the risks of euglycemic ketocacidosis. Fasting, hypovolemia, infection, surgery, bowel preparation, keto diets before bariatric procedures, excessive alcohol are some of the predisposing conditions. Treatment involve some aggressive rehydration and Potassium supplementation with Insulin infusion and sometimes bicarbonate. Prevention may necessitate withholding SGLT2 Inhibitors for up to three days, more than the recommended 24 hours.

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