BMJ Case Reports 2017; doi:10.1136/bcr-2017-220600
  • Reminder of important clinical lesson

Postgastric bypass hypoglycaemia in a patient with end-stage renal disease: a diagnostic and management pitfall

  1. Richard Pratley5
  1. 1Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
  2. 2Department of Internal Medicine, Florida Hospital, Orlando, Florida, USA
  3. 3Department of Research, Florida Hospital, Orlando, Florida, USA
  4. 4Florida Hospital, Orlando, Florida, USA
  5. 5Department of Endocrinology, Florida Hospital, Orlando, Florida, USA
  1. Correspondence to Dr Sameen Khalid,{at}
  • Accepted 25 May 2017
  • Published 15 June 2017


Roux-en-Y gastric bypass (RYGB) surgery is currently one of the most popular procedures to aid weight loss. Hypoglycaemia associated with gastric bypass surgery is an underdiagnosed but life-threatening potential consequence of the surgical procedure. We present a case of a 44-year-old woman with end-stage renal disease presenting with refractory hypoglycaemia after 10 years of RYGB. Extensive history and work-up excluded medications, renal disease, insulinoma and dumping syndrome as the cause of hypoglycaemia. Dietary modifications or pharmacological trial of drugs did not ameliorate her symptoms with progressive worsening of hypoglycaemia leading to continuous dextrose infusion. Distal pancreatectomy was performed with subsequent resolution of hypoglycaemia. Surgical pathology results showed diffuse hyperplastic islet cells, confirming the diagnosis of postgastric bypass hypoglycaemia.


  • Contributors All authors listed on the submitted manuscript have read and agreed to its content and meet the authorship requirements. SK made substantial contributions to the design and was involved in drafting the manuscript. AB was involved in drafting the manuscript and in revising it critically for important intellectual content. FNUA-u-R was involved in drafting the manuscript. RP was involved in revising the manuscript and has given final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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