Article Text

Download PDFPDF
Non-diabetic euglycaemic ketoacidosis and rapid weight loss in a post-traumatic surgical patient: is the outré preventable?
  1. Yun Xin Chin1,
  2. Nivan Loganathan2 and
  3. Dinoo Suran Kirthinanda2
  1. 1Department of Anaesthesia, Intensive Care and Pain Medicine, Singapore General Hospital, Singapore
  2. 2Department of Anaesthesiology, Jurong Health Campus, National University Health System, Singapore
  1. Correspondence to Dr Dinoo Suran Kirthinanda;{at}


To highlight the implications of the metabolic stress response and the role of anaesthesia in attenuating its deleterious effects, we present this extremely rare case of non-diabetic euglycaemic ketoacidosis with rapid weight loss in a post-traumatic surgical patient. Ketoacidosis is the accumulation of ketone bodies in blood and is generally associated with relative or absolute insulin deficiency secondary to diabetes mellitus, sodium–glucose cotransporter 2 inhibitors and extensive fasting. The stress of systemic disease, trauma or surgery in such predisposed patients could precipitate ketoacidosis. Our patient developed high anion gap metabolic acidosis intraoperatively due to ketosis, a potentially life-threatening complication, without any predisposing factors as a result of metabolic stress of major trauma and surgery. Aiding the interpretation, he lost 15 kg weight perioperatively, suggesting his body was in a hypercatabolic state. This report emphasises the value of anaesthetic techniques to prevent such rare complications.

  • Anaesthesia
  • Metabolic disorders
  • Surgery

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors DSK conceived the idea of the case report and participated in the design, data collection, analysis, drafting of the manuscript, revision of the manuscript and approval of the final manuscript. YXC and NL participated in data collection, analysis, drafting of the manuscript, revision of the manuscript and approval of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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