Perioperative Euglycemic Diabetic Ketoacidosis in Nondiabetic Patients Receiving Hyperthermic Intraperitoneal Chemotherapy: A Case Series

Euglycemic diabetic ketoacidosis (EDKA) is associated with diabetes, alcohol use, pregnancy, and use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Thus far, it has been described in the setting of cardiac surgery and a cohort of patients undergoing pancreaticoduodenectomy (Whipple) surgery. This case series is the first to describe the occurrence of perioperative euglycemic diabetic ketoacidosis in a cohort of nondiabetic patients not on SGLT-2 inhibitors undergoing hyperthermic intraperitoneal chemotherapy (HIPEC). We recommend measurement of ketones during or after surgery when EDKA is suspected to initiate therapy in a timely fashion.