C3.2 R5: Submit an ADR report to appropriate authority

Submitted an ADR report through the Fraser Health Intranet


  • Click on PSLS on FH intranet
  • Click “Enter a Safety Report”
  • Report “Adverse Drug Reaction”
  • Updated ADR on Medi-tech and Medi-net


Adverse Drug Reaction: Euglycemic DKA and fungal UTI

Suspected Medication: Canagliflozin 300mg PO once daily (has been on it x 1 year)

  • s/s: progressive nausea, vomiting, tachycardic
  • At time of admission: anion gap metabolic acidosis with bicarbonate of 11, anion gap of 13, pH of 7.14 and CO2 of 23 on VBG.¬† capillary blood glucose was 12.7.¬† Beta hydroxybutyrate at 6.6
  • Normal lactate in the context of metformin use at 1.8.
  • Blood glucose ranged from 6 to 10 during hospital stay (Sept 9 to 12)

Treatment of reaction:

  • Invokana and Metformin was held on Sept 9, 2016.
  • Insulin IV infusion with potassium supplementation was started for DKA from Sept 9 to Sept 11/16, and was transitioned to insulin sliding scale for remainder of stay.
  • On Sept 10/16, patient looks well and on Sept 12, 2016, he feels near normal.
  • Upon discharge on Sept 13, despite being asymptomatic, beta-hydroxybutyrate is still elevated at 0.7
  • His fungal urinary tract infection was treated with fluconazole 200mg daily for 14 day (as out-patient)

Patient Info:
Other Medications he was on:

  • Clarithromycin 500mg by mouth twice daily for presumed tonsilitis (Filled Sept 6 for 10 days)
  • Metformin 1000mg by mouth twice daily
  • Tramadol 37.5mg/Acetaminophen 325mg – 1 to 2 tablets by mouth every 6 hours as needed
  • Acetaminophen 650mg – 2 tablets twice daily
  • Vitamin D and Vitamin B12


Relevant history and pre-existing medical conditions:

  • T2DM since 2010 (HbA1c 6.8% on Sept 11/2016)
  • Not a smoker, No alcohol