SAT-541 Empagliflozin Induced Acute Pancreatitis

Abstract Disclosure: H. Marasandra Ramesh: None. T. Hammad: None. S. Zahra: None. J. Ma: None. V. Zeykan: None. Introduction: Empagliflozin is a sodium-glucose co-transporter inhibitor used in the treatment of type 2 diabetes mellitus. They effectively decrease blood glucose levels by reducing renal reabsorption of glucose. Common adverse effects associated with it are urinary tract infections, and genitourinary fungal infections. Here, we report a case of empagliflozin- induced pancreatitis as a rare side effect. Case presentation: A 65-year-old male with a past medical history of type 2 diabetes mellitus on metformin, insulin lispro and glargine, empagliflozin, gastroesophageal reflux, hypertension, presented to the hospital with chief complaints of epigastric pain for 2 weeks associated with diarrhea. Detailed medication reconciliation history was relevant for initiation of empagliflozin 3 months prior to the presentation. The epigastric pain was 8/10 in intensity at times, radiating to the back and occasionally waking him up from sleep. He also had a couple of episodes of diarrhea in 1 week. He endorsed having decreased appetite and had lost about 40 lbs in the last 4 months. He had chronic symptoms of reflux which worsened in the last one week. Social history negative for smoking and alcohol intake. Physical examination pertinent for epigastric tenderness and groin fungal infection. Labs revealed mildly elevated lipase levels of 84 U/L, normal liver function tests, normal triglycerides and HbA1c of 7.2%. The stool panel was unremarkable. CT abdomen and pelvis showed acute interstitial edematous pancreatitis. His clinical scenario along with CT abdomen findings were consistent with suspected acute pancreatitis secondary to empagliflozin. He was treated conservatively with intravenous fluids, ondansetron and pain medications. He symptomatically improved over the course of time and was able to tolerate oral fluids with advancement in diet. He did not have any recurrent episodes of acute pancreatitis upon discontinuing empagliflozin. Conclusion: Drug-induced acute pancreatitis can be precipitated by drugs such as angiotensin-converting enzyme inhibitors, statins, diuretics, oral contraceptives, dipeptidyl peptidase-4 inhibitors. It is imperative to consider drug-induced pancreatitis as one of the differentials while working up the cause of acute pancreatitis. In this case, the clues to diagnosis included detailed medication reconciliation which revealed the temporal association between the onset of symptoms and the initiation of empagliflozin. A Naranjo score of 4 also supported that empagliflozin could be the most probable cause of acute pancreatitis considering the temporal sequence. The mainstay of treatment includes cessation of the culprit drug and conservative management with intravenous fluids and pain management. Presentation: Saturday, July 12, 2025