This article is more than 5 years old. Information may no longer be current.
DKA common after bariatric surgery in high-risk patients with type 1 diabetes, obesity
Patients with type 1 diabetes, obesity and poor glycemic control undergoing bariatric surgery are at risk for developing diabetic ketoacidosis, particularly those experiencing postoperative infection, prolonged poor oral intake and severe dehydration, according to recent findings.
Ali Aminian, MD, bariatric surgeon at Cleveland Clinic's Digestive Disease Institute, and colleagues analyzed data from 12 patients who developed diabetic ketoacidosis (DKA) within 90 days after bariatric surgery at an academic center between 2005 and 2015 (10 women; mean age, 49 years; mean preoperative BMI, 43.1 kg/m²; eight with type 1 diabetes). Within the cohort, three patients had a history of DKA; 11 were using insulin before surgery, and all had poor preoperative glycemic control (mean HbA1c, 9.3%). Six patients underwent Roux-en-Y gastric bypass; four patients underwent laparoscopic sleeve gastrectomy; two underwent laparoscopic adjustable gastric banding. Median interval between surgery and development of DKA was 12 days. Nausea, vomiting and abdominal pain were the common presenting symptoms, according to researchers.
Ali Aminian
Researchers observed that eight patients were noncompliant with their insulin therapy or had inadequate insulin therapy; three of these patients developed DKA in the immediate postoperative period before hospital discharge. Infection was a precipitating factor for DKA in four of the patients; poor oral intake for several days was a possible factor in the DKA of three patients, the researchers wrote.
Several patients experienced adverse events while in DKA, including acute kidney injury (n = 2), deep vein thrombosis (n = 1), aspiration pneumonia (n = 1) and iatrogenic pneumothorax (n = 1). Two patients with respiratory insufficiency required intubation and mechanical ventilation. No deaths were reported.
“High-risk patients should be informed about warning symptoms, signs and predisposing factors of postoperative DKA,” the researchers wrote. “Anesthesia and surgical stress, abrupt discontinuation of insulin or inadequate treatment in the perioperative period, postoperative infection, prolonged poor oral intake and severe dehydration can be precipitating causes for postoperative DKA.”
Researchers noted that adjustment of basal insulin is needed when patients are on a low-calorie diet; in addition, the insulin regimen and dosage should be tailored after development of a postoperative infection.
“Surgeons, endocrinologists, and anesthesiologists should be aware of this rare but serious postoperative complication, which can be preventable,” Aminian told Endocrine Today. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.