St. David's South Austin Medical Center Austin, TX
Lauren Lyssy, DO1, Jeremy Polman, DO, MS, MBA2 1St. David's South Austin Medical Center, Austin, TX; 2St. David's South Austin Medical Center, Nashville, TN
Introduction: Dapagliflozin obtained FDA approval in 2014 for the treatment of type 2 diabetes mellitus and has since shown additional benefits in patients with congestive heart failure and chronic kidney disease. Nausea is the most common gastrointestinal side effect (reported by about 3% of patients), with pancreatitis very rarely occurring. Here, we discuss a patient presenting with their first episode of pancreatitis shortly after dapagliflozin initiation.
Case Description/Methods: A 71-year-old female with type 2 diabetes mellitus presented with 1 day of epigastric abdominal pain associated with nausea and vomiting. The abdominal pain was sharp, radiated to the back, and had been constant since awakening the day before. Her only home medications were metformin, dapagliflozin (initiated 2 months prior), and acetaminophen (as needed). Surgical history included a remote laparoscopic cholecystectomy for the treatment of symptomatic cholelithiasis. She endorsed the consumption of 1-2 glasses of wine per week. On admission, vital signs were unremarkable. Physical examination demonstrated epigastric abdominal pain without distension. Lab work showed WBC 11,600, calcium 10, AST 42, ALT 65, ALP 139, triglycerides 233, and lipase 579. CT abdomen revealed prominence of the distal pancreas with adjacent fat stranding consistent with acute pancreatitis. In the setting of classic abdominal pain and characteristic imaging findings, the diagnosis of acute pancreatitis was made. Dapagliflozin was discontinued and supportive care was initiated. Due to the unclear etiology of pancreatitis, an MRCP was performed. The prominence of the distal pancreas was again noted, without ductal dilation or masses present. The common bile, cystic, and pancreatic ducts were unremarkable, and the gallbladder was surgically absent. The patient’s abdominal pain, nausea, and vomiting completely resolved and she was discharged home on hospital day 2.
Discussion: Pancreatitis is a well-known side effect of certain classes of diabetic medications but has been rarely reported in patients taking SGLT-2 (sodium-glucose cotransporter 2) inhibitors, such as dapagliflozin and empagliflozin. In these patients, the mechanism of pancreatitis remains unclear. With the expanding indications for SGLT-2 inhibitors, providers should remain aware of the increased risk of pancreatitis in patients taking these medications.
Disclosures:
Lauren Lyssy indicated no relevant financial relationships.
Jeremy Polman indicated no relevant financial relationships.
Lauren Lyssy, DO1, Jeremy Polman, DO, MS, MBA2. P2949 - Pinning Down the Culprit: A Unique Case of Pancreatitis Related to Dapagliflozin, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
