Título Em Endocrinologia E Metabologia Practice Questions - TEEM - Título De Especialista Em Endocrinologia E Metabologia (SBEM AMB) Exam

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A 52-year-old woman with type 2 diabetes treated with dapagliflozin 10 mg and metformin 1,000 mg twice daily undergoes elective laparoscopic cholecystectomy. Forty-eight hours postoperatively, she develops tachypnea, nausea, vomiting, and diffuse abdominal pain. Capillary blood glucose is 158 mg/dL. Arterial blood gas demonstrates pH 7.18, pCO2 22 mmHg, HCO3 8 mEq/L, and serum anion gap of 22 mEq/L. Blood beta-hydroxybutyrate is elevated at 4.8 mmol/L. What is the diagnosis and what is the key preventive measure recommended by SBEM/SBD regarding SGLT2 inhibitors?

Euglycemic Diabetic Ketoacidosis (CAD euglicêmica); SGLT2 inhibitors must be withheld at least 3 to 4 days prior to elective major surgery. Metformin-associated lactic acidosis (MALA); metformin should have been replaced with a sulfonylurea preoperatively. Acute post-cholecystectomy pancreatitis; SGLT2 inhibitors can be safely continued throughout the perioperative period. Secondary adrenal insufficiency precipitated by surgical stress; SGLT2 inhibitors have no impact on perioperative ketoacidosis.

Correct Answer:

Euglycemic Diabetic Ketoacidosis (CAD euglicêmica); SGLT2 inhibitors must be withheld at least 3 to 4 days prior to elective major surgery.

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