A 51-year-old woman with type 2 diabetes mellitus developed euglycemic diabetic ketoacidosis (euDKA) in the post-operative setting after robotic-assisted sleeve gastrectomy. She developed tachycardia on post-operative day (POD) 1 before developing altered mental status and tachypnea on POD 2. The diagnosis was ultimately made by discovering ketonuria in the setting of anion gap metabolic acidosis despite repeatedly normal blood glucose levels. Pre-operatively, her blood glucose levels were managed with sodium-glucose co-transporter-2 (SGLT-2) inhibitor-containing combination pill, Invokamet (R), as well as basal-bolus insulin regimen consisting of aspart (NovoLog (R)) and glargine-lixisenatide (Soliqua (R)). SLGT-2 inhibitors have been associated with an increased risk of euDKA, particularly in the context of severe bodily stressors such as surgery. EuDKA is a difficult diagnosis to make because of the lack of characteristic severe hyperglycemia that is typical of DKA. Clinicians should be mindful of euDKA in the post-operative setting of diabetic patients, particularly for those on SGLT-2 inhibitors.
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, England
Univ Coll London Hosp, Biomed Res Ctr, Natl Inst Hlth Res, London W1T 7DN, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Makaronidis, Janine M.
Neilson, Sabrina
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Neilson, Sabrina
Cheung, Wui-Hang
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Cheung, Wui-Hang
Tymoszuk, Urszula
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Tymoszuk, Urszula
Pucci, Andrea
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Pucci, Andrea
Finer, Nicholas
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Finer, Nicholas
Doyle, Jacqueline
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Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Doyle, Jacqueline
Hashemi, Majid
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Hashemi, Majid
Elkalaawy, Mohamed
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, England
Univ Alexandria, Med Res Inst, Clin & Expt Surg Dept, Alexandria 21561, EgyptUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Elkalaawy, Mohamed
Adamo, Marco
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Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Adamo, Marco
Jenkinson, Andrew
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Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Jenkinson, Andrew
Batterham, Rachel L.
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, England
Univ Coll London Hosp, Biomed Res Ctr, Natl Inst Hlth Res, London W1T 7DN, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, England
Univ Coll London Hosp, Biomed Res Ctr, Natl Inst Hlth Res, London W1T 7DN, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Makaronidis, Janine M.
Neilson, Sabrina
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Neilson, Sabrina
Cheung, Wui-Hang
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Cheung, Wui-Hang
Tymoszuk, Urszula
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Tymoszuk, Urszula
Pucci, Andrea
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Pucci, Andrea
Finer, Nicholas
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Finer, Nicholas
Doyle, Jacqueline
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Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Doyle, Jacqueline
Hashemi, Majid
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Hashemi, Majid
Elkalaawy, Mohamed
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, England
Univ Alexandria, Med Res Inst, Clin & Expt Surg Dept, Alexandria 21561, EgyptUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Elkalaawy, Mohamed
Adamo, Marco
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h-index: 0
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Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Adamo, Marco
Jenkinson, Andrew
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Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Jenkinson, Andrew
Batterham, Rachel L.
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h-index: 0
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UCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England
Univ Coll London Hosp, Bariatr Ctr Weight Management & Metab Surg, Ground Floor West Wing,250 Euston Rd, London NW1 2PG, England
Univ Coll London Hosp, Biomed Res Ctr, Natl Inst Hlth Res, London W1T 7DN, EnglandUCL, Dept Med, Rayne Inst, Obes Res Ctr, London WC1E 6JF, England