Perioperative medicine & outcomes
A Systematic Review and Expert Evaluation of Perioperative SGLT2 Inhibitor‐Associated Ketoacidosis Case Reports
Authors' conclusion
Confirming a SAPKA diagnosis is challenging due to the variable reporting quality and numerous confounding factors present during the perioperative period.
Study context
- Population
- Patients with metabolic acidosis and ketones who used SGLT2i in the perioperative setting93 papers
- Participants
- 128 patients
- Outcome
- Likelihood of SGLT2i-associated postoperative ketoacidosis (SAPKA), as judged by a diabetes expert panel
Methodological detailssystematic literature search, quality assessment, expert panel questionnaire
- Systematic literature search
- Quality assessment
- Expert panel questionnaire
Pooled result
As reported in the abstract
Expert-judged likelihood of SAPKA
- 'Likely'
- 53 (41%)
- 'Possible'
- 38 (30%)
- 'Unlikely'
- 27 (21%)
- Could not be validated (insufficient data or implausible timing)
- 10 (8%)
- Likely or possible
- 71% (91/128)
Further pooled results
Common factors in SGLT2i-associated postoperative ketoacidosis (SAPKA) reports
- T2D mellitus diagnosis
- 115
- Impaired perioperative intake
- 30
- Insufficient insulin supplementation
- 10
Treatment and outcome
- Insulin treatment effective; ketoacidosis resolved in all surviving patients
Safety
- Significant morbidity, incl. ICU admission, in a substantial proportion of cases
Original publication
A Systematic Review and Expert Evaluation of Perioperative SGLT2 Inhibitor‐Associated Ketoacidosis Case Reports. Acta Anaesthesiol Scand. Published 13 May 2026. doi:10.
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