PMID- 35966831
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220816
IS  - 1178-7007 (Print)
IS  - 1178-7007 (Electronic)
IS  - 1178-7007 (Linking)
VI  - 15
DP  - 2022
TI  - Euglycaemic Ketoacidosis Due to Extremely Low-Calorie Intake and Dehydration 
      After Laparoscopic Sleeve Gastrectomy in a Patient with Type 2 Diabetes.
PG  - 2377-2380
LID - 10.2147/DMSO.S373712 [doi]
AB  - 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.
CI  - (c) 2022 Liu et al.
FAU - Liu, Zhaoxiang
AU  - Liu Z
AUID- ORCID: 0000-0001-7016-5917
AD  - Department of Endocrinology, Beijing Tsinghua Changgung Hospital, School of 
      Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.
FAU - Xiao, Luqi
AU  - Xiao L
AUID- ORCID: 0000-0003-1470-6023
AD  - Department of Endocrinology, Beijing Tsinghua Changgung Hospital, School of 
      Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.
FAU - Jin, Chenxi
AU  - Jin C
AD  - Department of Endocrinology, Beijing Tsinghua Changgung Hospital, School of 
      Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.
FAU - Xiao, Jianzhong
AU  - Xiao J
AD  - Department of Endocrinology, Beijing Tsinghua Changgung Hospital, School of 
      Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.
FAU - Zhao, Wenhui
AU  - Zhao W
AUID- ORCID: 0000-0001-7493-8921
AD  - Department of Endocrinology, Beijing Tsinghua Changgung Hospital, School of 
      Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.
LA  - eng
PT  - Case Reports
DEP - 20220806
PL  - New Zealand
TA  - Diabetes Metab Syndr Obes
JT  - Diabetes, metabolic syndrome and obesity : targets and therapy
JID - 101515585
PMC - PMC9365319
OTO - NOTNLM
OT  - bariatric surgery
OT  - euglycaemic ketoacidosis
OT  - type 2 diabetes mellitus
COIS- The authors have no relevant financial interests to disclose.
EDAT- 2022/08/16 06:00
MHDA- 2022/08/16 06:01
PMCR- 2022/08/06
CRDT- 2022/08/15 03:48
PHST- 2022/05/18 00:00 [received]
PHST- 2022/07/30 00:00 [accepted]
PHST- 2022/08/15 03:48 [entrez]
PHST- 2022/08/16 06:00 [pubmed]
PHST- 2022/08/16 06:01 [medline]
PHST- 2022/08/06 00:00 [pmc-release]
AID - 373712 [pii]
AID - 10.2147/DMSO.S373712 [doi]
PST - epublish
SO  - Diabetes Metab Syndr Obes. 2022 Aug 6;15:2377-2380. doi: 10.2147/DMSO.S373712. 
      eCollection 2022.