Patients on SGLT2 inhibitors need to pause treatment if they are unwell or about to undergo major surgery, diabetologists say, amid increasing reports of ketoacidosis associated with the drugs.

The Australian Diabetes Society has updated an alert, warning doctors about the “small but definite risk” of severe diabetic ketoacidosis (DKA) that has landed surgical patients in ICU.

DKA risk is elevated in patients who are dehydrated, fasting, have undergone bowel preparation or a surgical procedure, and have an intercurrent illness such as an active infection.

It should also be considered in those who develop abdominal pain, nausea, vomiting, fatigue or unexplained acidosis.