Drugs causing DKA

Q: Name at least five drugs that can cause Diabetic Keto-Acidosis (DKA)?

Answer: DKA can be induced for various reasons, particularly in Type 1 diabetic patients. Medications are one of them. From an ICU perspective following drugs are important:

• glucocorticoids
• higher-dose thiazide diuretics
• dobutamine (sympathomimetic) 
• terbutaline (sympathomimetic)
• "atypical" antipsychotics
• sodium-glucose co-transporter 2 (SGLT2) inhibitors (known to cause DKA with euglycemia among inpatients)
• cocaine (can cause recurrent DKA)

#endocrinology

References:

1. Kitabchi AE, Murphy MB. Consequences of insulin deficiency. In: Atlas of Diabetes, 4th, Skyler J (Ed), Springer US, New York 2012. p.39.

2. Newcomer JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 2005; 19 Suppl 1:1.

3. Taylor SI, Blau JE, Rother KI. SGLT2 Inhibitors May Predispose to Ketoacidosis. J Clin Endocrinol Metab 2015; 100:2849

4. Nyenwe EA, Loganathan RS, Blum S, et al. Active use of cocaine: an independent risk factor for recurrent diabetic ketoacidosis in a city hospital. Endocr Pract 2007; 13:22.