BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors inhibit SGLT2, which is expressed in the proximal renal tubule, and thus reduce blood glucose levels by enabling the urinary excretion of excess glucose. SGLT2 inhibitors have been reported to suppress the complications of diabetes and reduce overall mortality. However, little is known about the types of symptoms that may occur in response to an overdose of an SGLT2 inhibitor. Here, we describe a case of intoxication caused by an overdose of an SGLT2 inhibitor. CASE PRESENTATION An otherwise physically healthy adult woman ingested an overdose of ipragliflozin, an SGLT2 inhibitor, and a polypill of olmesartan medoxomil, and azelnidipine in a suicide attempt. Although her blood ipragliflozin concentration was very high (9516.3 ng/mL) upon hospital arrival, her initial blood glucose level was normal, and she did not exhibit symptoms such as hypoglycemia or polyuria. Moderate renal dysfunction associated with an estimated glomerular filtration rate of 42.3 mL/min/1.73 m2 was observed. Thirty-six hours after ingestion, her blood ipragliflozin concentration decreased to a level equivalent to that observed after a therapeutic dose and her renal function improved almost simultaneously. After improvement in her renal function, the osmotic diuretic effect of the drug progressed. Her blood glucose level declined slightly but was in the normal range due to glucose administration. During the clinical course, fatal hypoglycemia was not observed. CONCLUSIONS Our case showed that an overdose of an SGLT2 inhibitor caused toxic effects on renal function, but severe hypoglycemia was not observed. Additional cases of intoxication from SGLT2 inhibitors alone would be helpful to clarify the mechanism of intoxication.

中文翻译：

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钠-葡萄糖共转运蛋白2抑制剂过量引起的严重中毒：一例。

背景技术钠-葡萄糖共转运蛋白2（SGLT2）抑制剂抑制在近端肾小管中表达的SGLT2，并因此通过允许尿中过量葡萄糖的排泄降低血糖水平。据报道，SGLT2抑制剂可抑制糖尿病并发症并降低总死亡率。但是，对于过量服用SGLT2抑制剂可能出现的症状类型知之甚少。在这里，我们描述了由过量的SGLT2抑制剂引起的中毒事件。病例介绍一名身体健康的成年女性摄入了过量的伊普拉列净，SGLT2抑制剂，奥美沙坦medoxomil和azelnidipine多药，试图自杀。尽管她的血液伊普列净浓度在住院时非常高（9516.3 ng / mL），她的初始血糖水平正常，没有出现低血糖或多尿症等症状。观察到中度肾功能不全，估计肾小球滤过率达42.3 mL / min / 1.73 m2。摄入三十六小时后，她的血浆伊格列净浓度降低到与治疗剂量后所观察到的水平相等，并且肾功能几乎同时改善。肾功能改善后，该药物的渗透性利尿作用得以发展。她的血糖水平略有下降，但由于服用葡萄糖而处于正常范围。在临床过程中，未观察到致命的低血糖症。结论我们的病例表明过量服用SGLT2抑制剂对肾功能有毒性作用，但未观察到严重的低血糖症。