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Retrospective review of SGLT2 inhibitor exposures reported to 13 poison centers.
Clin Toxicol (Phila). 2018 03; 56(3):204-208.CT

Abstract

BACKGROUND

SGLT2 inhibitors are a new class of oral antidiabetics prescribed in the United States since 2013. They act by inhibiting reabsorption of glucose in the proximal convoluted tubule of the kidney, allowing excess glucose to be excreted. Little has been reported regarding effects of non-therapeutic exposure to this class of medication.

METHODS

Retrospective records from 13 poison centers were examined for human exposures to SGLT2 inhibitors between 1st January 2013 and 31st December 2016. Exclusion criteria included multi-substance exposures and exposures without any follow-up call. Data examined included patient age, chronicity of exposure, clinical effects, management site, treatments administered, duration of follow-up, and outcome.

RESULTS

Eighty-eight cases met inclusion criteria. Patient age ranged from 1 to 75 years; 49 were evaluated in a health care facility with 18 admissions. No symptoms developed in 80 (91%) patients, 6 (7%) developed minor symptoms, and 2 (2%) developed moderate symptoms. Hypoglycemia was not observed. Mean time to final follow-up was 9.3 h, ranging from 1 to 42 h; median was 6 h. Of the two patients who developed moderate symptoms, one was a 65 year old male who developed metabolic acidosis and hypokalemia while taking canagliflozin therapeutically; the other a 43-year-old female who developed tachycardia and mild hypertension following the intentional ingestion of 6000 mg of canagliflozin.

DISCUSSIONS

The number of patients evaluated in a health care facility is most likely reflective of a cautious approach to dealing with a new class of drug. Exposures were generally well-tolerated and managed with minimal intervention.

CONCLUSIONS

In this retrospective series, acute ingestions of SGLT2 inhibitors were well-tolerated with no hypoglycemia and only minor effects. For young children with unintentional ingestions, a reasonable approach to home management would include at least one follow-up for signs and symptoms of possible toxicity including mental status changes, polyuria, or tachypnea.

Authors+Show Affiliations

a Oklahoma Center for Poison and Drug Information , Oklahoma City , OK , USA.b Illinois Poison Center , Chicago , IL , USA.c Central Ohio Poison Center , Columbus , OH , USA.d Florida Poison Information Center , Tampa Tampa , FL , USA.e West Texas Regional Poison Center , El Paso , TX , USA.f Louisiana Poison Center , Shreveport , LA , USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28812381

Citation

Schaeffer, Scott E., et al. "Retrospective Review of SGLT2 Inhibitor Exposures Reported to 13 Poison Centers." Clinical Toxicology (Philadelphia, Pa.), vol. 56, no. 3, 2018, pp. 204-208.
Schaeffer SE, DesLauriers C, Spiller HA, et al. Retrospective review of SGLT2 inhibitor exposures reported to 13 poison centers. Clin Toxicol (Phila). 2018;56(3):204-208.
Schaeffer, S. E., DesLauriers, C., Spiller, H. A., Aleguas, A., Baeza, S., & Ryan, M. L. (2018). Retrospective review of SGLT2 inhibitor exposures reported to 13 poison centers. Clinical Toxicology (Philadelphia, Pa.), 56(3), 204-208. https://doi.org/10.1080/15563650.2017.1357824
Schaeffer SE, et al. Retrospective Review of SGLT2 Inhibitor Exposures Reported to 13 Poison Centers. Clin Toxicol (Phila). 2018;56(3):204-208. PubMed PMID: 28812381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective review of SGLT2 inhibitor exposures reported to 13 poison centers. AU - Schaeffer,Scott E, AU - DesLauriers,Carol, AU - Spiller,Henry A, AU - Aleguas,Alfred, AU - Baeza,Salvador, AU - Ryan,Mark L, Y1 - 2017/08/16/ PY - 2017/8/16/pubmed PY - 2019/5/7/medline PY - 2017/8/17/entrez KW - Dapagliflozin KW - antidiabetic KW - canagliflozin KW - empagliflozin KW - poisoning KW - toxicity SP - 204 EP - 208 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 56 IS - 3 N2 - BACKGROUND: SGLT2 inhibitors are a new class of oral antidiabetics prescribed in the United States since 2013. They act by inhibiting reabsorption of glucose in the proximal convoluted tubule of the kidney, allowing excess glucose to be excreted. Little has been reported regarding effects of non-therapeutic exposure to this class of medication. METHODS: Retrospective records from 13 poison centers were examined for human exposures to SGLT2 inhibitors between 1st January 2013 and 31st December 2016. Exclusion criteria included multi-substance exposures and exposures without any follow-up call. Data examined included patient age, chronicity of exposure, clinical effects, management site, treatments administered, duration of follow-up, and outcome. RESULTS: Eighty-eight cases met inclusion criteria. Patient age ranged from 1 to 75 years; 49 were evaluated in a health care facility with 18 admissions. No symptoms developed in 80 (91%) patients, 6 (7%) developed minor symptoms, and 2 (2%) developed moderate symptoms. Hypoglycemia was not observed. Mean time to final follow-up was 9.3 h, ranging from 1 to 42 h; median was 6 h. Of the two patients who developed moderate symptoms, one was a 65 year old male who developed metabolic acidosis and hypokalemia while taking canagliflozin therapeutically; the other a 43-year-old female who developed tachycardia and mild hypertension following the intentional ingestion of 6000 mg of canagliflozin. DISCUSSIONS: The number of patients evaluated in a health care facility is most likely reflective of a cautious approach to dealing with a new class of drug. Exposures were generally well-tolerated and managed with minimal intervention. CONCLUSIONS: In this retrospective series, acute ingestions of SGLT2 inhibitors were well-tolerated with no hypoglycemia and only minor effects. For young children with unintentional ingestions, a reasonable approach to home management would include at least one follow-up for signs and symptoms of possible toxicity including mental status changes, polyuria, or tachypnea. SN - 1556-9519 UR - https://wwww.unboundmedicine.com/medline/citation/28812381/Retrospective_review_of_SGLT2_inhibitor_exposures_reported_to_13_poison_centers_ DB - PRIME DP - Unbound Medicine ER -