Farxiga

[gator2886]

Thoughts on Farxiga when patients are on it for Heart failure? Hold? Maintain?

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[CopaceticOne]

Thoughts on Farxiga when patients are on it for Heart failure? Hold? Maintain?

https://www.ncbi.nlm.nih.gov/books/NBK554570/

 

[Maverikk]

Also:

Preoperative Cessation of SGLT2i - American College of Cardiology

www.acc.org

although from what I've read it's only case reports, but it resulted in an FDA warning, the physiology of it is a little suspect to me though

 

[Ronin786]

Have definitely seen multiple cases of euglycemic DKA post-operatively from it. That said, I can't say that any of them have clinically behaved like DKA, it's usually just an unexplained metabolic acidosis +/- lactemia. And I wonder whether all these patients would do fine eventually when they stop being NPO.

 

[Maverikk]

Have definitely seen multiple cases of euglycemic DKA post-operatively from it. That said, I can't say that any of them have clinically behaved like DKA, it's usually just an unexplained metabolic acidosis +/- lactemia. And I wonder whether all these patients would do fine eventually when they stop being NPO.

What was the clinical presentation? It must’ve been pretty bad for multiple case reports to get an fda warning, like they must’ve been re-intubated to get an abg and have it worked up. I’ll have to look into the case reports

 

[gator2886]

Thanks for the info. Anyone else? Still not sure to hold or maintain for CHF.

 

[Ronin786]

What was the clinical presentation? It must’ve been pretty bad for multiple case reports to get an fda warning, like they must’ve been re-intubated to get an abg and have it worked up. I’ll have to look into the case reports

All my patients were in the ICU for separate reasons related to their surgery and not the SGLT-i

 

[Guillemot]

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001285

 

[BlueRug]

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001285

Yeah don't agree with everything by AHA, but SGLT2 continued can absolutely lead to issues. Not in the OR, but mostly afterwards.

The acidosis can be a PITA in the OR but can certainly prolong intubation, ICU LOS, etc. Not sure if there is an increased mortality signal found in a study thus far, but wouldn't be the slightest surprised.

What's the benefit of continuing vs holding for 3 days? Some hyperglycemia and fluid retention?