8337 A Case Report of Polypharmacy With Combined Adverse Effects of SGLT-2 Related Euglycemic DKA and Lithium Induced Nephrogenic DI

Abstract Disclosure: U.D. Gupta: None. S.N. Subedi: None. K. Kunwar: None. B. Ghimire: None. G. Dhakal: None. J.B. Bagain: None. S.R. Ishrat: None. Polypharmacy, typically defined as the use of 5 to 10 medications, is linked to an elevated risk of adverse drug events (ADEs) and hospital admissions, independent of age. In the USA, 67 percent of hospitalizations are linked to four medications or classes: warfarin, insulins, oral antiplatelet agents, and oral hypoglycemic agents. A higher number of medications increases the likelihood of "prescribing cascades," where an ADE is mistaken for a new medical condition, leading to additional drug therapy. In our case report we are presenting a 41 years old female with a medical history of Hypertension, Diabetes Mellitus Type 2, Schizoaffective disorder, presented to the emergency department with left gluteal pain with subsequent CT scan shows Fournier's gangrene or perforated perirectal abscess and she received IV antibiotics, pain management, and fluids. Patient has been taking Lantus, Glipizide (sulfonylurea), and Empagliflozin, Bupropion and Aripiprazole at home. During her treatment of sepsis she was diagnosed with euglycemic DKA (A1c - 10.3, Blood glucose 240-180s, anion gap metabolic acidosis, glucosuria >1000, Ketone bodies of 40, beta hydroxybutyrate 3.18, serum osmolality 303, urine osmolality 140, urine output 13 liters/24 hrs). Furthermore Lithium Level reported 0.1(mild toxicity 1.5 mEq/L or 1.5 mmol/L). In literature, Sodium-glucose cotransporter 2 (SGLT2) inhibitors can reduce lithium levels. Polyuria and polydipsia are common in lithium-treated patients (70% cases), with potential risk factors including longer treatment duration, episodes of toxicity, and concurrent use of other psychotropic medications. In some cases, the lack of significant hyperglycemia (plasma glucose <250 mg/dL ) can lead to a delayed identification of issues by both patients and clinicians (risk is 2 times higher than other therapies), it is recommended to check for serum ketones. The patient received treatment for other comorbidities; however, Lithium and Empagliflozin were withheld during her hospital stay, leading to gradual improvement. This case report will enforce the importance of ensuring appropriate drug prescribing involves factors such as avoiding inappropriate medications, monitoring for side effects and drug levels, preventing drug interactions, and incorporating patient values through active involvement. This case is an unique opportunity to learn ADEs, contributing to diagnostic challenges which can increase mortality across various age groups without proper vigilance. Presentation: 6/3/2024