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SGLT2 inhibitor ketoacidosis — GPhC CRA MCQ

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HardEndocrine TherapeuticsSGLT2 inhibitor ketoacidosisGPhC CRA

A 58-year-old woman takes dapagliflozin 10mg daily and metformin for type 2 diabetes. She is 2 days post-operative, eating very little and reports nausea, abdominal pain and rapid breathing. Her glucose is 9.8mmol/L on a home meter. What monitoring is required?

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Correct answer: A — Urgent ketone assessment with medical review

SGLT2 inhibitors can be associated with diabetic ketoacidosis, sometimes with normal or moderately raised glucose. Post-operative fasting, nausea, abdominal pain and rapid breathing are red flags. Urgent ketone assessment and medical review are needed; glucose alone is insufficient. Annual diabetes monitoring does not address the acute risk.

Reference: BNF Dapagliflozin; MHRA Drug Safety Update