12^th Global Gastroenterologists Meeting

Sodium glucose co-transport 2 inhibitors SGLT2i are novel class of antidiabetic medications approved for management of type two diabetes. Their weight reducing characteristics and oral mode of administration make them more appealing for use in patients with diabetes and obesity. Thus, more patients referred for body contouring surgery are started on these medications. Increasing evidence is showing that diabetic ketoacidosis with euglycemia is a serious risk associated with their use and can present few days post operatively. We present a case of a 44 years old patient who underwent elective standard abdominoplasty and bilateral mastopexy (superiorly based pedicle with vertical scar) following weight loss of 8.5 stone over a 5-year period. She had type 2 diabetes and her antidiabetic medications included metformin, liraglutide and empagliflozin. Towards the end of the first postoperative day, she reported gradual onset of nausea, vomiting and abdominal pain. Urgent investigations showed severe diabetic ketoacidosis with euglycemia. She was managed with fluid resuscitation, insulin infusion and intravenous sodium bicarbonate in the high dependency unit. She made a complete clinical and biochemical recovery and was discharged on day nine postoperatively. This case illustrates an emerging serious complication of diabetes in the postoperative period associated with this class of antidiabetic medications.