P127 | Dapagliflozin and acute pancreatitis: a case report

F. Pugliese, R. Falzone, L. Lenzi, M. Pizzini, S. Cozzio | Internal Medicine S. Maria del Carmine Rovereto, APSS Trento, Italy

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2-i), are increasingly used not only in diabetes but also for heart failure. The literature shows several case reports of acute pancreatitis (AP) attributed to SGLT2-i, especially with coadministration of dipeptidyl peptidase 4 inhibitor (DPP-4i), glucagon-like peptide 1 analog (GLP-1RA), ACE i, and statins.
Case report: A 59-year-old male with a history of dilated cardiomyopathy and post cholecystectomy status arrived at the emergency room with a 2 day history of epigastric pain. He denied alcohol intake. On physical examination, temperature 38°C, blood pressure 90/60 mmHg, pulse 98/min, and respiratory rate 18/min, saturating 96% on room air. His abdomen was diffusely tender to palpation. Initial labs were notable for a leukocyte count of  0.8×109/L, calcium 8.8 mg/dL, lipase 2378 U/L, and triglyceride of 48 mg/dL. HbA1c and IgG4 was normal. Infectious causes are excluded. Drugs history was positive for valsartan/sacubitril, in association with a dapagliflozin, started 6 months before. While waiting for diagnostic tests, SGLT2-i was promptly discontinued. It was started on conservative treatment with parenteral fluid and pain management. Computer tomography scan, magnetic resonance imaging and echoendoscopy showed AP, without biliary ductal dilatation or choledocholithiasis and no pancreas divisum.
Conclusions: Physicians should consider SGLT2-i a possible cause of pancreatitis having ruled out any other etiologies. Patients should be informed about the symptoms of AP and advised to discontinue SGLT2-i.