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Acute antibody-mediated rejection — ESENeph MCQ

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HardRenal TransplantationAcute antibody-mediated rejectionESENeph

A patient taking dapagliflozin reports nausea, abdominal pain and rapid breathing while glucose is 8.2 mmol/L. What is the safest interpretation?

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Correct answer: C — Suspect euglycaemic ketoacidosis and arrange ketone testing

The best answer is “Suspect euglycaemic ketoacidosis and arrange ketone testing”. SGLT2 inhibitors can cause ketoacidosis with only modest glucose elevation, so compatible symptoms require urgent ketone and acid–base assessment and withholding the drug. “Exclude ketoacidosis because glucose is below 11 mmol/L” misses the euglycaemic presentation. “Continue dapagliflozin and recheck glucose next week” risks progression of a medical emergency. “Treat the symptoms as predictable osmotic diuresis alone” does not explain abdominal pain and rapid breathing safely. “Increase dapagliflozin to improve ketone clearance” would intensify the precipitating pharmacology.

Reference: UK Kidney Association SGLT2 inhibitor guideline: https://guidelines.ukkidney.org/sodium-glucose-co-transporter-2/