RESUMO
Postoperative euglycemic diabetic ketoacidosis (euDKA) associated with sodium-glucose cotransporter-2 (SGLT2) inhibitor use has been well-documented and carries a Food and Drug Administration recommendation to hold SGLT2 inhibitors 3 to 4 days before a planned surgical procedure. Unfortunately, many surgical procedures, such as orthotopic heart transplant (OHT), are unplanned and unpredictable. With the increasing use of SGLT2 inhibitors in diabetic and non-diabetic heart failure patients, new challenges in patient management and perioperative risk have arisen. We report a case in which SGLT2 inhibitor-associated euDKA complicated the postoperative course of a prediabetic patient who had undergone OHT.
Assuntos
Diabetes Mellitus Tipo 2 , Cetoacidose Diabética , Transplante de Coração , Estado Pré-Diabético , Inibidores do Transportador 2 de Sódio-Glicose , Cetoacidose Diabética/induzido quimicamente , Cetoacidose Diabética/diagnóstico , Glucose , Transplante de Coração/efeitos adversos , Humanos , Sódio , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversosRESUMO
The infectious disease coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. The impact of COVID-19 on solid organ transplantations, including heart transplantation, is currently unclear. Many transplant programs have been forced to swiftly re-evaluate and adapt their practices, leading to a marked decrease in transplants performed. This trend has been due to various factors, including increased donor COVID-19 screening scrutiny and recipient waiting list management in anticipation of COVID-19 critical care surge capacity planning. In the face of these unknown variables, determining when and how to proceed with transplantation in our population of patients with end-stage cardiomyopathies is challenging. Here, we describe our center's experience with orthotopic heart transplantation (OHT) in one of the country's pandemic epicenters, where we performed eight OHTs in the first 2 months after community spread began in late February 2020.
Assuntos
COVID-19/prevenção & controle , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Complicações Pós-Operatórias/prevenção & controle , Idoso , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/etiologia , Teste para COVID-19 , Feminino , Humanos , Controle de Infecções/métodos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Resultado do TratamentoAssuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Educação em Farmácia/métodos , Transplante de Órgãos , Pandemias , Farmacêuticos , Pneumonia Viral/complicações , Transplantados , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2RESUMO
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly infecting people worldwide, resulting in the infectious disease coronavirus disease 19 (COVID-19) that has been declared a pandemic. Much remains unknown about COVID-19, including its effects on solid organ transplant (SOT) recipients. Given their immunosuppressed state, SOT recipients are presumed to be at high risk of complications with viral infections such as SARS-CoV-2. Limited case reports in single SOT recipients, however, have not suggested a particularly severe course in this population. In this report, we present a dual-organ (heart/kidney) transplant recipient who was found to have COVID-19 and, despite the presence of a number of risk factors for poor outcomes, had a relatively mild clinical course.
