Sodium-glucose cotransporter 2-associated perioperative ketoacidosis: a protocol for SAPKA systematic review

BackgroundIn recent years, reports have increased regarding patients treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i) who develop severe ketoacidosis during the perioperative period. This systematic review aims to extrapolate precipitating factors from case reports of SGLT2i-associated perioperative ketoacidosis. MethodsTwo independent researchers will search PubMed, EMBASE, and Web of Science, up to June 1, 2022, with no language restrictions, to identify reports of perioperative ketoacidosis associated with SGLT2i use. We will include case reports/series describing patients taking SGLT2i who developed ketoacidosis (defined as blood pH < 7.3 and blood or urine ketone positivity) pre-, intra-, or postoperatively up to 30 days following surgery. Patients for whom SGLT2i was newly prescribed postoperatively and those for whom the diagnosis of ketoacidosis does not fulfill our criteria will be excluded. Competing interest statementDr. Yasuda reports receiving grants from Ono Pharmaceutical and Mitsubishi Tanabe Pharma Corporation. Funding statementThe Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (C) (Grant Number 21K06676) funded this study.