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SGLT2 inhibitor ketoacidosis — GPhC CRA MCQ

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HardEndocrine TherapeuticsSGLT2 inhibitor ketoacidosisGPhC CRA

A 54-year-old man taking dapagliflozin and metformin for type 2 diabetes phones with vomiting, abdominal pain and rapid breathing after a viral illness. His glucose is 9.8mmol/L and he has not eaten properly for 24 hours. What monitoring is required?

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Reveal the answer and explanation

Correct answer: D — stop dapagliflozin temporarily and seek urgent assessment for possible ketoacidosis

SGLT2 inhibitors can cause diabetic ketoacidosis, sometimes with only moderately raised glucose. Vomiting, abdominal pain and rapid breathing are concerning symptoms, especially during acute illness and reduced intake. The medicine should be withheld and urgent assessment arranged, including ketone testing. Continuing dapagliflozin could worsen the situation.

Reference: BNF; MHRA drug safety update; NICE CKS: Diabetes type 2