Sick Day Rules Statin Continue Others Stop — ESENeph MCQ

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HardAcute Kidney InjurySick Day Rules Statin Continue Others StopESENeph

A patient taking dapagliflozin presents after three days of poor intake with nausea, abdominal pain and tachypnoea. Glucose is 9.8 mmol/L, ketones 5.6 mmol/L, pH 7.19 and bicarbonate 12 mmol/L. What is the most likely diagnosis?

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Correct answer: C — SGLT2-associated euglycaemic ketoacidosis

SGLT2 inhibitors can produce ketoacidosis with only modest glucose elevation, particularly during fasting, acute illness or perioperative stress. The high ketones and anion-gap metabolic acidosis establish euglycaemic DKA. Dapagliflozin should be stopped and the patient treated using a DKA pathway with insulin, dextrose, fluids and electrolyte monitoring. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG28: Type 2 diabetes in adults—initial medicines. https://www.nice.org.uk/guidance/ng28/chapter/initial-medicines