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2018 ; 7
(1
): 29-33
Nephropedia Template TP
gab.com Text
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English Wikipedia
Development of hyperkalemia following treatment with dapagliflozin (DAPA) in a
patient with type 2 diabetes after bilateral adrenalectomy
#MMPMID29134558
Miyaoka D
; Tsuda A
; Hayashi N
; Toi N
; Yamasaki A
; Nagata Y
; Nakatani S
; Kurajoh M
; Yamada S
; Morioka T
; Imanishi Y
; Emoto M
; Inaba M
CEN Case Rep
2018[May]; 7
(1
): 29-33
PMID29134558
show ga
Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 (SGLT2) inhibitor, is
known to have a beneficial diuretic effect, in addition to a glucose-lowering
effect. Although SGLT2 inhibitor has been reported, the increase of hyperkalemia
in patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors,
their mechanism of action is unclear. We report the first case of a type 2
diabetes (T2DM) patient with potential mineralocorticoid deficiency who developed
hyperkalemia after administration of DAPA. A 79-year-old woman underwent
bilateral adrenalectomy for uncontrolled hypercortisolism due to an inoperable
recurrence of Cushing's disease, and she was subsequently maintained on
replacement therapy with glucocorticoid. She was diagnosed as having T2DM at
71 years of age and was treated with sitagliptin and miglitol. Since she
presented with weight gain of about 5 kg over 6 months and her HbAlc level
increased over 12%, 5 mg/day DAPA was added to her daily regimen. After the start
of DAPA treatment, she developed hyperkalemia (6.5 mEq/L) with increased plasma
renin activity of 53.1 ng/mL/h. She was diagnosed with aldosterone deficiency and
started on fludrocortisone 0.1 mg daily, after which the hyperkalemia improved
immediately. In this case, DAPA treatment could potentially increase the
requirement for mineralocorticoid replacement, directly suggesting that the SGLT2
inhibition-induced natriuretic effect is accompanied by compensatory activation
of the RAAS axis, which is essential to keep the serum potassium level within the
normal range. Therefore, physicians should be careful about the development of
hyperkalemia in patients when SGLT2 and RAAS inhibitors are used in combination.