canagliflozin ( invokana ) is a novel therapy for type 2 diabetes mellitus ( dm ) approved in a new class acknowledged as sodium - glucose co - transporter 2 ( sglt2 ) inhibitors .
canagliflozin inhibits the glucose reabsorption by the kidney , increasing glucose elimination and reducing blood glucose levels in diabetic patients .
acute pancreatitis is a very rare but severe side effect with an incidence < 1% .
we report a case of a 50-year - old man who received a few doses of canaglifozin and developed pancreatitis - induced diabetic ketoacidosis requiring hospitalization in the intensive care unit .
a 50-year - old white man presented to the emergency department with malaise , weakness , abdominal pain , and loss of vision that progressively worsened over 3 days .
he has a history of a long - standing well - controlled type 2 dm treated with insulin , glyburide , and metformin .
4 days before admission his endocrinologist stopped his lantus ( insulin glargine ) and prescribed him on canagliflozin 100 mg oral daily along with glyburide and metformin .
after 10 days of treatment , he developed malaise , weakness , abdominal pain that progressively worsened . on the day of the presentation , he developed blurry vision .
blood test showed blood glucose of 506 mg / dl ; sodium of 125 , potassium 6.8 , chloride of 94 , total carbon dioxide < 5 and anion gap of 26 meq / l ; creatinine 2.0 mg / dl , trop i was negative ; amylase 643 , lipase 982 u / l , aspartate aminotransferase 18 u / l ; total bilirubin 0.9 mg / dl ; atrial blood gas ph 6.85 , partial pressure of carbon dioxide 11 mmhg , partial pressure of oxygen 149 mmhg , bicarbonate 1.9 mmol / l , and electrocardiogram showed normal sinus rhythm but no st - t change .
he was diagnosed diabetic ketoacidosis induced by acute pancreatitis along with acute kidney injury from dehydration . computed tomography of abdomen demonstrated the evidence of acute inflammation of pancreas .
the patient denied any history of recent alcohol use and his serum triglyceride level was normal at 95 mg / dl ( normal range , < 150 mg / dl ) .
his serum creatinine , sodium , potassium , lipase , and amylase level returned to normal after 3 days , and we could stop insulin infusion after the anion gap returned to the normal range .
the patient continues to do well at 2-month follow - up visit without any recurrent symptoms .
canagliflozin is one of sglt2 inhibitors and has been approved by the food and drug administration for type 2 dm by inhibiting sglt2 in the proximal renal tubules .
canagliflozin reduces the reabsorption of filtered glucose from the tubular lumen and lowers the renal threshold for glucose ( rtg ) .
sglt2 is the main site of filtered glucose reabsorption ; reduction of filtered glucose reabsorption and lowering of rtg result in increased urinary excretion of glucose , thereby reducing plasma glucose concentrations .
its safety and effectiveness were assessed in nine clinical trials involving over 10,285 patients with type 2 dm .
the most common adverse effects described in the clinical trials were genital yeast infections , urinary tract infections , and increased urination .
anaphylaxis , acute respiratory distress syndrome , or significant electrolyte abnormalities have not been demonstrated in the literature review .
an ongoing trial , canagliflozin cardiovascular assessment study , will provide us more information on risks of malignancies , serious cases of pancreatitis , and other adverse events . in summary , our case demonstrates very rare but serious side - effect , acute pancreatitis in the use of canagliflozin . as the utility of canagliflozin expands
 canagliflozin ( invokana ) is an innovative treatment for type 2 diabetes mellitus ( dm ) approved in a new class acknowledged as sodium - glucose co - transporter 2 inhibitors . 
 acute pancreatitis is a very rare side effect with an incidence < 1% . a 50-year - old white male with dm type 2 presented to the emergency department with acute onset of abdominal pain after 4 days treatment with canagliflozin . 
 he was successfully diagnosed with diabetic ketoacidosis induced by acute pancreatitis . 
 canagliflozin was discontinued . 
 his diabetic ketoacidosis was improved after aggressive intravenous fluid along with intravenous insulin infusion . 
 our case demonstrates very rare but serious side effect , acute pancreatitis in the use of canagliflozin . as the utility of canagliflozin expands 
 , physicians must be aware of this potentially fatal adverse effect . 
 more specific details on potential candidates for this novel therapy are urgently needed . 
Introduction
Case Report
Discussion