Preoperative assessment: SGLT2 inhibitors: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: SGLT2 inhibitors

Sample item

A diabetic patient on empagliflozin is scheduled for elective surgery. What is the recommended preoperative step and why?

ADouble the dose the previous nightBContinue it up to the morning of surgery to maintain glucose controlCStop it about 3 days before surgery to avoid euglycaemic ketoacidosisDSwitch to a sulphonylurea on the morning of surgery

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Stop it about 3 days before surgery to avoid euglycaemic ketoacidosis

SGLT2 inhibitors cause glycosuria and ketosis and can produce euglycaemic diabetic ketoacidosis during fasting and surgical stress. They are withheld for at least 3 days (4 days for ertugliflozin) before elective surgery.

Option by option

A. Double the dose the previous night
Doubling the dose would increase the risk.
B. Continue it up to the morning of surgery to maintain glucose control
Continuing increases the risk of ketoacidosis with normal glucose.
C. Stop it about 3 days before surgery to avoid euglycaemic ketoacidosis (correct)
Correct. Stopping 3 days before avoids euglycaemic ketoacidosis.
D. Switch to a sulphonylurea on the morning of surgery
A sulphonylurea would cause hypoglycaemia during fasting.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Stop it about 3 days before surgery to avoid euglycaemic ketoacidosis. SGLT2 inhibitors cause glycosuria and ketosis and can produce euglycaemic diabetic ketoacidosis during fasting and surgical stress.

Why is "Double the dose the previous night" not the answer?

Doubling the dose would increase the risk.

Why is "Continue it up to the morning of surgery to maintain glucose control" not the answer?

Continuing increases the risk of ketoacidosis with normal glucose.

Why is "Switch to a sulphonylurea on the morning of surgery" not the answer?

A sulphonylurea would cause hypoglycaemia during fasting.

What concept does this question test?

It tests Preoperative assessment: SGLT2 inhibitors in Anaesthesia. They are withheld for at least 3 days (4 days for ertugliflozin) before elective surgery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: SGLT2 inhibitors?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.