Sleiwah Aseel, McBride Michael, Black Claire E
Department of Plastic Surgery, The Ulster Hospital, Belfast, UK.
Department of Plastic Surgery, Royal Victoria Hospital, Belfast, UK.
BMJ Case Rep. 2017 Aug 9;2017:bcr-2017-220253. doi: 10.1136/bcr-2017-220253.
A woman aged 44 underwent elective standard abdominoplasty and bilateral mastopexy (superiorly based pedicle with vertical scar) following weight loss of 8.5 stone (53.9 kg) 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. Her condition continued to deteriorate overnight, becoming tachycardic and tachypnoeic. Urgent investigations showed severe diabetic ketoacidosis with euglycaemia. 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 9 postoperatively. This case illustrates a diagnostic challenge of a serious life-threatening complication of diabetes in the postoperative period associated with a novel class of antidiabetic medications, sodium-glucose cotransporter 2 inhibitors.
一名44岁女性在5年内体重减轻了8.5英石（53.9千克）后，接受了择期标准腹部整形术和双侧乳房上提术（带垂直瘢痕的上蒂法）。她患有2型糖尿病，抗糖尿病药物包括二甲双胍、利拉鲁肽和恩格列净。术后第一天快结束时，她报告逐渐出现恶心、呕吐和腹痛。她的病情在夜间持续恶化，出现心动过速和呼吸急促。紧急检查显示严重糖尿病酮症酸中毒伴血糖正常。她在高依赖病房接受了液体复苏、胰岛素输注和静脉注射碳酸氢钠治疗。她在临床和生化方面完全康复，并于术后第9天出院。该病例说明了术后与新型抗糖尿病药物钠-葡萄糖协同转运蛋白2抑制剂相关的糖尿病严重危及生命并发症的诊断挑战。
