Empagliflozin Related to Ketoacidosis and Early Neurological Deterioration in a Patient with Acute Ischemic Stroke

第二型鈉－葡萄糖轉運蛋白抑制劑相關的酮酸中毒和早期神經功能惡化：急性缺血中風單一個案報告

林欣儀(Shin-Yi Lin) ； 黃幟芬(Chih-Fen Huang) ； 湯頌君(Sung-Chun Tang) ； 鄭建興(Jiann-Shing Jeng)

《台灣中風醫誌》 3卷1期 (2021/03) Pp. 64-72

https://doi.org/10.6318/FJS.202103_3(1).0005

摘要

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are new class of anti-diabetic agents and display benefits in cardiovascular protection. SGLT2i are recommended as part of a glucose-lowering regimen among type 2 diabetic patients with established cardiovascular disease. Nevertheless, the side effect of euglycemic diabetic ketoacidosis (euDKA) should not be overlooked, especially among patients with acute illness or impaired oral intake. We present the case of a 66-year-old woman admitted for acute ischemic stroke over the right pontine who had used empagliflozin 25 mg daily and metformin 850 mg twice daily to treat hyperglycemia, and developed euDKA and early neurological deterioration after 3 days. From the data of large-scale clinical trials, the benefit of empagliflozin in stroke is controversial, but their effects of osmotic diuresis, lowered blood pressure, and hemoconcentration can be thwarted during an acute stroke. Carefully evaluating the proper time to start therapy and closely monitoring the symptoms of euDKA is important.

關鍵字

ischemic stroke ； sodium-glucose cotransporter-2 inhibitor ； euglycemic diabetic ketoacidosis empagliflozin ； diabetes mellitus

並列摘要

第二型鈉－葡萄糖轉運蛋白（sodium-glucose cotransporter-2〔SGLT2〕）抑制劑已證實能夠改善心血管疾病相關預後，因此是糖尿病合併心血管疾病患者的建議用藥之一。然而，在急性疾病或進食不佳的病人，使用SGLT2抑制劑可能導致正常血糖之酮酸中毒症。本文探討一位66歲女性病人因急性中風入院，在加護病房照護期間選用SGLT2抑制劑作為血糖控制藥物，卻誘發正常血糖之酮酸中毒症以及早期神經功能惡化的案例。事實上，SGLT2抑制劑並不能顯著降低中風的發生，但其藥理機轉導致的滲透壓性利尿與降低血壓等作用可能在中風急性期造成症狀的惡化。因此在急性中風病人應審慎評估開始使用SGLT2抑制劑的時機，並密切監測正常血糖之酮酸中毒症相關症狀。

並列關鍵字

缺血中風 ； 第二型鈉－葡萄糖轉運蛋白抑制劑 ； 糖尿病酮酸中毒