title: Tacrolimus-Induced Diabetic Ketoacidosis and Effect of Switching to Everolimus: A Case Report.
abstract: BACKGROUND
  New-onset diabetes after transplantation (NODAT) is a common metabolic complication. Most conventional immunosuppressive medications, especially steroids and tacrolimus, are responsible for its development. NODAT may rarely be associated with severe, life-threating complications in kidney transplantation recipients.
  
  
  METHODS
  A 44-year-old man was admitted to our polyclinic for a routine post kidney transplantation visit. He reported polyuria, polydipsia, and general weakness. The patient had undergone preemptive, living-related kidney transplantation 5 weeks previously. Immunosuppressive treatment comprised tacrolimus, prednisolone, and mycophenolate mofetil. Physical examination revealed no abnormalities except signs of mild dehydration. Although he had no history of diabetes before kidney transplantation and his serum fasting glucose levels were within the reference range at the follow-up visits, his laboratory tests revealed high serum glucose and creatinine levels, ketosis, and metabolic acidosis. Our diagnosis was NODAT with diabetic ketoacidosis and prerenal azotemia. Initial treatment comprised intravenous saline and insulin infusion and subsequently involved intensive subcutaneous insulin administration. Despite the intensive insulin therapy and reduction of the tacrolimus dose, sufficient glucose regulation was not achieved. Tacrolimus was switched to everolimus on day 6 of hospitalization. The patient's insulin requirement gradually decreased to one-half of the primary dose over the following several days, and he was discharged on day 10 with successful serum glucose regulation. Although the diabetogenic potential of sirolimus is similar to that of tacrolimus, the impact of everolimus on glucose metabolism remains unclear.
  
  
  CONCLUSIONS
  We have reported a life-threating metabolic complication associated with tacrolimus and successful treatment of NODAT by switching from tacrolimus to everolimus.
authors.affiliation: Department of Nephrology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey. Electronic address: drmrtgc@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Tuğcu
authors.affiliation: Department of Nephrology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
authors.forename: U
authors.initials: U
authors.lastname: Kasapoğlu
authors.affiliation: Department of Nephrology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Boynueğri
authors.affiliation: Department of Nephrology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Can
authors.affiliation: Department of Urology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
authors.forename: A M
authors.initials: AM
authors.lastname: Gökçe
authors.affiliation: Department of Nephrology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ç
authors.initials: Ç
authors.lastname: Ruhi
authors.affiliation: Department of General Surgery and Transplantation, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Titiz
mesh_terms: D000328:Adult; D016883:Diabetic Ketoacidosis / Q000139:chemically induced* / Q000628:therapy; D000068338:Everolimus / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D007328:Insulin; D000068338:Everolimus; D016559:Tacrolimus