Post-Bariatric Metabolic Emergency: A Case of DKA in a Non-Insulin-Dependent Patient
https://doi.org/10.15605/jafes.041.S1
- Author:
Izzah Zafirah Jusoh
1
;
M.K. Mohd Firdaus
1
;
W.H. Wan Mohd Hafez
1
;
M.A. Masliza Hanuni
1
Author Information
1. Endocrinology Unit, Medical Department, Hospital Sultanah Nur Zahirah
- Publication Type:Journal Article
- MeSH:
Bariatrics
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):62-63
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Bariatric surgery is an effective treatment for morbid
obesity and metabolic syndrome, including type 2 diabetes
mellitus. However, metabolic complications such as diabetic
and starvation ketoacidosis may occur in the perioperative
period, particularly in patients with reduced oral intake,
rapid weight loss, and altered insulin requirements.
Case:A 37-year-old male with type 2 diabetes mellitus, hypertension, dyslipidemia, and morbid obesity (body mass index
60 kg/m²) was referred for bariatric surgery. Preoperatively,
he was initiated on subcutaneous semaglutide 1 mg weekly
for weight optimization, resulting in weight loss from 178
to 127 kg. His hemoglobin A1c was 9.5%. He subsequently
underwent laparoscopic proximal jejunal bypass sleeve
gastrectomy on 5 November 2025.
Two weeks postoperatively, he reported lethargy and was
clinically found to be dehydrated, following poor tolerance
of nourishing fluids and inadequate caloric intake.
Capillary blood glucose was 7.6 mmol/L. Investigations
revealed metabolic acidosis with markedly elevated serum
ketones (4.9 mmol/L), consistent with ketoacidosis. He
was commenced on an intravenous insulin infusion and
aggressive IV fluid resuscitation. Attempts to discontinue
insulin infusion resulted in recurrent ketoacidosis, attributed to poor tolerance of nourishing fluids. Following
multidisciplinary input involving endocrinologists, a
diabetes educator, and a dietitian, he was able to tolerate
enteral nutritional supplementation. Insulin infusion was
successfully discontinued, and he was discharged on a
basal bolus subcutaneous insulin regimen.
Conclusion:Ketoacidosis following bariatric surgery is an
underrecognized complication and may occur even in
patients with type 2 diabetes mellitus and relatively
normal blood glucose levels. Contributing factors included
prolonged caloric deprivation, rapid weight loss, postsurgical catabolic state, and relative insulin deficiency.
Recently used glucagon-like peptide-1 receptor agonist
may have further suppressed appetite, compounding
postoperative nutritional intolerance. The involvement
of a multidisciplinary team, including endocrinologists, a
dietician, diabetic educators, and surgical teams, is essential
to optimize outcomes and prevent severe complications.
- Full text:2026080316245024922EP_A079.pdf
