One case of euglycemic diabetic ketoacidosis caused by ertugliflozin tablets combined with polyethylene glycol loxenatide injection

doi:10.19803/j.1672-8629.20250913

Abstract

Abstract: Objective To analyze the risks and mechanism of euglycemic diabetic ketoacidosis (euDKA) induced by the combination of ertugliflozin tablets and polyethylene glycol loxenatide injection in order to contribute to the safety of clinical medications. Methods The treatment process of a patient who developed euDKA after using the aforementioned drug combination was analyzed while the mechanism and risk factors were investigated based on literature. Results The patient’s condition improved after discontinuation of suspected drugs and symptomatic treatment. Conclusion The combination of ertugliflozin tablets and polyethylene glycol loxenatide injection may induce euDKA. Clinicians should assess the condition of an individual patient, offer pharmaceutical care and provide related information to ensure safe medications.

Key words: Ertugliflozin Tablets, Polyethylene Glycol Loxenatide Injection, Euglycemic Diabetic Ketoacidosis (euDKA), Sodium Glucose Transporter 2 Inhibitors (SGLT2i), Pharmacovigilance, Adverse Drug Reaction

CLC Number:

Sun Qian, Yu Ying. One case of euglycemic diabetic ketoacidosis caused by ertugliflozin tablets combined with polyethylene glycol loxenatide injection[J]. Chinese Journal of Pharmacovigilance, 2026, 23(8): 941-943.

Add to citation manager EndNote|Ris|BibTeX

URL: https://zgywjj.magtechjournal.com/EN/10.19803/j.1672-8629.20250913

https://zgywjj.magtechjournal.com/EN/Y2026/V23/I8/941

References

[1] Chinese Diabetes Society.Guideline for the prevention and treatment of diabetes mellitus in China (2024 edition)[J]. Chinese Journal of Diabetes Mellitus(中华糖尿病杂志), 2025, 17(1): 16-139.
[2] Zang Shasha, Tang Yong, Tan Lili, et al.Research progress on the antidiabetic mechanisms and applications of sodium-glucose cotransporter 2 inhibitors[J]. Modern Medical Journal(现代医学), 2024, 52(2): 305-309.
[3] Shang Yongfang, Yang Ying, Li Ying, et al.Three cases of euglycemic diabetic ketoacidosis induced by dapagliflozin and literature review[J]. Journal of Qingdao University(Medical Sciences)(青岛大学学报医学版), 2023, 59(3): 439-441.
[4] Liu Jing, Zhou Xianghai.Consensus on glycemic management for patients with coronary heart disease and type 2 diabetes[J]. Chinese Circulation Journal(中国循环杂志), 2024, 39(4): 342-352.
[5] Brown E, Heerspink H J L, Cuthbertson D J, et al. SGLT2 inhibitors and GLP-1 receptor agonists: established and emerging indications[J]. The Lancet, 2021, 398(10296): 262-276.
[6] Zhang Min, Xu Yuan, Li Juan.A case of ketoacidosis due to type 2 diabetes treated with semaglutide combined with ertugliflozin[J]. Chinese Journal of Pharmacoepidemiology(药物流行病学杂志), 2025, 34(3): 346-352.
[7] Lu Yun, Cao Fang, Tang Zhenghe.Gastric retention and ketoacidosis induced by combined use of semaglutide and empagliflozin[J]. Adverse Drug Reactions Journal(药物不良反应杂志), 2025, 27(1): 56-58.
[8] National Center for Adverse Drug Reaction Monitoring, China. Pharmacovigilance newsletter[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2016, 13(3): 190-192.
[9] Yuan Menghu, Qian Fengdan.Analysis of ketoacidosis induced by dapagliflozin tablets[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2020, 17(3): 157-160.
[10] Cai Jun, Liu Simin, Li Huixin, et al.Literature analysis of dapagliflozin-induced euglycemic diabetic ketoacidosis[J]. Chinese Journal of Pharma-covigilance(中国药物警戒), 2020, 17(11): 808-812.
[11] Zheng Guimei, Xie Zeyu, Cheng Xiaoling, et al.One case of euglycemic diabetic ketoacidosis caused by metformin hydrochloride and empag-liflozin tablets(Ⅰ)[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2025, 22(6): 693-695, 698.
[12] Zhang Houjing, Ji Liwei.Analysis of adverse drug reactions induced by SGLT-2 inhibitors[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2021, 18(5): 478-482.
[13] Xu Hanwen, Zheng Juan, Dong Hua, et al.One case of euglycemic diabetic ketoacidosis caused by SGLT-2 inhibitors[J]. Chinese Journal of Rural Medicine and Pharmacy(中国乡村医药), 2025, 32(20): 29-30.
[14] Bai Ting, Zhu Lin, Yang Rui, et al.Characteristic analysis of adverse reactions of four sodium-glucose cotransporter-2 inhibitors based on WHO adverse drug reaction reporting database[J]. Clinical Medication Journal(临床药物治疗杂志), 2025, 23(2): 79-86.
[15] Boghdadly E K, Dhesi J, Fabb P, et al.Elective perioperative mana-gement of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists and sodium-glucose cotransporter-2 inhibitors: a multidisciplinary consensus statement[J]. Anaesthesia, 2025, 80(4): 412-424.
[16] Chandrakumar H P, Chillummuntala S, Singh G, et al.Postoperative euglycemic ketoacidosis in type 2 diabetes associated with sodium-glucose cotransporter 2 inhibitor: insights into pathogenesis and management strategy[J]. Cureus, 2021, 13(6), e15533.
[17] Louwagie E J, Diego J N, Farooqi C S, et al. Euglycemic ketoacidosis following coadministration of an SGLT2 inhibitor and tirzepatide[J]. JCEM Case Reports, 2025, 3(3): luaf028.
[18] Hu Zhanping, Xu Taijun.Risk factors of ketosis in patients with type 2 diabetes mellitus treated with SGLT-2 inhibitors[J]. Jilin Medical Journal(吉林医学), 2022, 43(4): 886-888.
[19] Specialty Committee of Hospital Pharmacy, Chinese Pharmaceutical Association. Expert consensus on clinical application of polyethylene glycol loxenatide[J]. Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2021, 41(24): 2507-2513, 2540.
[20] Naranjo A, Busto U, Sellers E M, et al.A method for estimating the proba-bility of adverse drug reactions[J]. Clinical Pharmacology & Therapeutics, 1981, 30(2): 239-245.
[21] Zhang Lina, Peng Xuejuan, Zhang Yu, et al.Analysis of adverse reactions and events of metformin associated lactic acidosis[J]. Inner Mongolia Medical Journal(内蒙古医学杂志), 2024, 56(11): 1305-1309.
[22] Koceva A, Kravos Tramšek N A. From sweet to sour: SGLT-2 inhibitor-induced euglycemic diabetic ketoacidosis[J]. Journal of Personalized Medicine, 2024, 14(7): 665.
[23] Shi Wenjing, Wu Zhaofang, Yu Yanli, et al.Research progress in the etiology of euglycemie diabetic ketoacidosis[J]. Chinese Journal of Diabetes(中国糖尿病杂志), 2024, 32(4): 317-320.
[24] Morace C, Lorello G, Bellone F, et al.Ketoacidosis and SGLT2 inhibitors: a narrative review[J]. Metabolites, 2024, 14(5): 264.
[25] Palmer B F, Clegg D J.Euglycemic ketoacidosis as a complication of SGLT2 inhibitor therapy[J]. Clinical Journal of the American Society of Nephrology, 2021, 16(8): 1284-1291.
[26] Veneti S, Grammatikopoulou M G, Kintiraki E, et al.Ketone bodies in diabetes mellitus: friend or foe?[J]. Nutrients, 2023, 15(20): 4383.