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SGLT2 renal function — GPhC CRA MCQ

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HardEndocrine TherapeuticsSGLT2 renal functionGPhC CRA

A patient taking dapagliflozin is admitted with acute appendicitis and will undergo surgery. Glucose is 8.9 mmol/L, urine ketones are negative and he is haemodynamically stable. What is the best medicines plan?

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Correct answer: B — Interrupt treatment and restart when blood ketones normalise and the patient is stable

SGLT2 inhibitors should be interrupted during major surgery or acute serious illness because euglycaemic ketoacidosis can occur despite modest glucose. Blood ketones are preferred to urine testing. Treatment can be restarted when ketones are normal and the patient is clinically stable with adequate intake and hydration; neither glucose alone nor the end of the procedure is sufficient.

Reference: MHRA Drug Safety Update, SGLT2 inhibitors—blood-ketone monitoring during treatment interruption: https://www.gov.uk/drug-safety-update/sglt2-inhibitors-monitor-ketones-in-blood-during-treatment-interruption-for-surgical-procedures-or-acute-serious-medical-illness