05 September 2023
: Case report 
Severe Ketoacidosis After One Anastomosis Gastric Bypass Surgery
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Clinical situation which can not be reproduced for ethical reasons
Nadav Nevo1BF, Giuseppe Evola2E, Carlo Sagnelli3E, Niv Pencovich1B, Gabriele Carbone3E, Corrado Rispoli3BDOI: 10.12659/AJCR.939581
Am J Case Rep 2023; 24:e939581
Table 2. Representative timeline of main events and treatments.
| POD | Clinical events | Blood analysis | Treatment |
|---|---|---|---|
| Day 1 | – Surgery uneventful– Patient stable after surgery | – IV hydration (normal saline + KCl) | |
| Day 2 | – Patient drowsy, fatigued, weak – Kussmaul breathing observed– No abdominal tenderness | – ABG (pH 7.104, HCO3 7 mmol/L, etc.)– Blood glucose (177–190 mg/dL)– Urinalysis positive for ketones | – Initiation of glucose and insulin therapy |
| Day 3 | – Improvement in fatigue and weakness, no Kussmaul breathing | – Blood gas analysis (pH 7.267, HCO3 11.9 mmol/L, etc.) | – Continued glucose and insulin therapy |
| Day 4 | – Patient fully recuperated | – Blood gas analysis (pH 7.35, HCO3 16.1 mmol/L, etc.) | – Continued glucose and insulin therapy |
| Day 5 | – Patient fully recuperated, blood gases normalized | – Blood gas analysis (pH 7.39, HCO3 20.2 mmol/L, etc.) | – Continued glucose and insulin therapy |
| Day 6 | – Patient discharged, feeling well, normal lab indices |