https://orcid.org/0000-0001-7016-5917
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Abstract
Background
Bariatric surgery is an effective therapy for type 2 diabetes mellitus (T2DM) and obesity. Euglycaemic ketoacidosis (EKA) has been reported in patients taking sodium-glucose cotransporter 2 (SGLT2) inhibitors after bariatric surgery. Cases of T2DM complicated with EKA without SGLT2 inhibitors after bariatric surgery are rarely reported.
Purpose
To present a case report of a T2DM patient (without SGLT2 inhibitor use) who developed EKA soon after laparoscopic sleeve gastrectomy.
Methods
Clinical records and interviews were used.
Results
A 35-year-old female patient was diagnosed with T2DM and obesity. The patient underwent laparoscopic sleeve gastrectomy to lose weight and control her blood glucose levels. Her daily fluid intake was 800–1000 mL, and her daily caloric intake was less than 500 kcal during the first days after the surgery. She was prescribed degludec insulin, metformin and dulaglutide and her blood sugar was lower than 13.9 mmol/L. On postoperative Day 6, the patient complained of fatigue and vomiting. Blood gas analysis and urine analysis supported the diagnosis of ketoacidosis. Fluid resuscitation, insulin and glucose were administered to the patient immediately. On postoperative Day 8, the patient recovered without any symptoms.
Conclusion
We report an extremely rare case of T2DM in which the patient developed EKA after laparoscopic sleeve gastrectomy owing to extremely low-calorie intake and dehydration. Physicians should be on alert for ketoacidosis in patients with T2DM after bariatric surgery with an euglycaemic status, even without the use of SGLT2 inhibitors or the presence of stresses, such as infection.
Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
Data Sharing Statement
All the data are fully available without restriction. All data generated or analyzed during this study are included in this published article.
Ethics Approval and Informed Consent
All procedures performed in this study involving human participants were in accordance with the ethical standards of the ethics committee of Tsinghua Changgung Hospital, and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from the patient included in the study. Publication of case report does not need ethical review in our institution.
Consent for Publication
Written informed consent for publication was obtained from the patient. A copy of the written consent is available by request.
Acknowledgments
We thank the patient for granting permission to publish this information.
Disclosure
The authors have no relevant financial interests to disclose.