Abstract
A 65-year-old man with type 2 diabetes began treatment with a SGLT2 inhibitor, as his obesity and high glucose level were not improved with his current therapy comprised of insulin and oral hypoglycemic agents. The patient received 50 mg of ipragliflozin after the withdrawal of metformin and thiazide. His blood glucose level decreased following the administration of ipragliflozin, and the dose of injected insulin was reduced by approximately 10 %. On the third day of ipragliflozin treatment, he developed severe hyperkalemia (7.3 mEq/l) in addition to generalized skin eruptions, ketosis (3-OHBA: 626 μmol/l), moderate metabolic acidosis (PH: 7.348, HCO3-: 18.3 mmol/l) and renal dysfunction (Cr: 1.6 mg/dl). His previous history of hyperkalemia, habit of eating seaweed (Kombu) containing a high amount of potassium and use of ARB therapy for hypertension may have contributed to the onset of hyperkalemia. In addition, the shift of potassium from the intra- to extracellular space increased by acidosis and insufficient action of insulin during SGLT2 treatment may have been a trigger. The patient's renal dysfunction and the withdrawal of thiazide would also have contributed to the abnormalities observed in this case. It is necessary to pay attention to the potassium level during SGLT2 treatment, especially in patients with a predisposition to hyperkalemia.
