Recent landmark trials have increased the use of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) in patients with type 2 diabetes (T2D). A rare but serious side effect of SGLT-2i is euglycemic diabetic ketoacidosis (euDKA), which usually occurs in the setting of acute illness such as the coronavirus disease 2019 (COVID-19). We report a distinctive case of a patient with hyperlipidemia and T2D on SGLT-2i therapy who presented with hypertriglyceridemia-induced pancreatitis (HTGP) concurrently with euDKA and COVID-19. The patient’s initial labs included venous blood gas pH of 7.27, a blood glucose level of 146 mg/dL, serum triglyceride (TG) greater than 8,300 mg/dL and lipase of 527 U/L. Viral polymerase chain reaction (PCR) result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was also positive. We suspect this patient has a primary disorder of lipoprotein metabolism which was exacerbated by stress from euDKA and COVID-19 infection. The patient was treated with intravenous fluids, fasting and intravenous insulin infusion. Resolution of euDKA and improvement of hypertriglyceridemia to less than 1,000 mg/dL occurred by day 6 and the patient was transitioned to subcutaneous basal-bolus insulin. On discharge, the SGLT-2i was discontinued and the patient was discharged on insulin, metformin, omega-3 fatty acids, and fenofibrate.
【저자키워드】 COVID-19, acute pancreatitis, hypertriglyceridemia, Euglycemic diabetic ketoacidosis, sodium-glucose cotransporter 2 inhibitors, 【초록키워드】 coronavirus disease, SARS-CoV-2, coronavirus, therapy, Trial, Stress, omega-3, discharge, serum, PCR, COVID-19 infection, Patient, Triglyceride, inhibitor, insulin, blood glucose, Resolution, T2D, intravenous, fatty acids, Diabetic, acute respiratory syndrome, Side effect, disorder, positive, hyperlipidemia, acute illness, intravenous fluids, lab, recent, venous blood gas, polymerase chain, initial, greater, occurred, the patient, exacerbated, treated, less, occur, discharged, lipoprotein metabolism, transitioned, type 2 diabete, 【제목키워드】 Pancreatitis, ketoacidosis, Type, Taking, Cotransporter,