The administration of arginine vasopressin to treat postoperative polyuria due to the prolonged effect of SGLT2 inhibitor

Abstract

A woman in her 80s was admitted for abdominal surgery. She was taking an SGLT2 inhibitor for diabetes and had been taken off the medication for 3 days before surgery. Diabetic ketoacidosis (DKA) is a side effect of SGLT2 inhibitors; however, it did not occur in this case. This was probably due to the use of added sugar infusions and insulin during the perioperative period. However, severe dehydration due to polyuria was observed on the first postoperative day. Central diabetes insipidus was initially suspected, and arginine vasopressin (AVP) was initiated. However, because of significant urinalysis, we concluded that the prolonged drug effect of SGLT2 inhibitors had caused polyuria. The initiation of SGLT2 inhibitors causes osmotic diuresis which occurs due to urinary glucose excretion. However, a compensatory response usually occurs, and the fluid balance is maintained without any dehydration. The AVP is involved in this process to maintain fluid homeostasis. In this case, the prolonged effect of the SGLT2 inhibitor and the defective secretion of AVP were thought to have caused polyuria. The patient's urinary output was controlled within the appropriate range by administering AVP. In this case, despite carrying out preoperative drug withdrawal, the patient still became dehydrated owing to polyuria caused by prolonged drug effect of SGLT2 inhibitors. We report this case because AVP is considered to be an effective treatment for polyuria.