We present here the case of a 45-year-old woman, a known case of type 2 diabetes mellitus (T2DM) for the last five years, poorly controlled with oral hypoglycemic medications including glimepiride, vildagliptin, and metformin. Serum ketones should be obtained in diabetic patients with symptoms of nausea, vomiting, or malaise while taking SGLT-2 inhibitors, and SGLT-2 inhibitors should be discontinued if ketoacidosis is confirmed. Given the absence of significant hyperglycemia, recognition of this entity by clinicians may be delayed.
In this report, our aim is to discuss the relationship between SGLT-2 inhibitors with eu-DKA. She was successfully treated according to the DKA protocol and discharged in good condition. Therefore, the diagnosis of euglycemic diabetic ketoacidosis (eu-DKA) was made. However, her lab results showed significant metabolic acidosis and ketonemia with no clinical or laboratory features of sepsis. Based on the clinical examination and lab findings, DKA was suspected, but her glucose level was below the cutoff value for DKA diagnosis. Before her presentation, her physician had recently added empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, to her anti-diabetic drug regimen along with glimepiride and a combination drug of vildagliptin and metformin. We discuss a case of a 45-year-old woman with T2DM who presented to the emergency room with worsening lethargy and weakness.
#SATISFACTORY PLASTIC SKIN#
To ensure that the skin graft will be 100% hairless, the prepared sheet of skin will be double checked through light illumination and the possible remaining hair follicles are meticulously extracted before the graft is tubed and inserted inside a newly constructed vagina.Diabetic ketoacidosis (DKA) is considered a medical emergency, most commonly associated with type 1 diabetes mellitus, and is relatively rare in type 2 diabetes mellitus (T2DM). Chettawut’s skin graft technique is delicate as the donor skin from scrotum and groin will be converted to be the intermediate thickness of skin graft which means the superficial part of dermal layer is preserved to maintain skin durability while the deep part of dermal layer which contains all hair follicles (hair roots) is discarded. The versatility of the non-penile inversion approach combined with scrotal and possible groin skin graft provides hope for those who have short penile length and those who have scarce scrotal skin and it yields outstanding results for both aesthetic external appearance and excellent vaginal depth.
The harvest of groin skin graft will not create any scar as the groin skin is adjacent to the surgical area in contrast to the obsolete technique that uses the abdominal skin which is located in an entirely different field. Chettawut can obtain additional skin graft from the groin to join the scrotal skin in order to complete the needed skin graft.
Chettawut uses the skin graft harvested from scrotal skin as the main source of skin graft for the lining inside a vagina.įor patients who do not have enough scrotal skin as a result of previous orchiectomy, hormone replacement therapy and many other factors which shrinks the skin, Dr. Since the penile skin is no longer inverted into the vaginal cavity, Dr. Chettawut carefully manages the valued penile skin for anatomically precise and natural look of the inner labia and vaginal opening by using his non-penile inversion technique which offers a more refined and defined aesthetic results of external genital appearance that is comparable to a cis female. Unlike the traditional penile inversion technique, Dr. Doctor Chettawut’s non penile inversion SRS with skin graft technique
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