TY - JOUR T1 - Novel cause of postoperative anion gap acidosis in a patient with diabetes following gastrectomy JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000977 VL - 7 IS - 1 SP - e000977 AU - Huda A Muhammad AU - Raja R Narayan AU - Marina Basina AU - George A Poultsides Y1 - 2022/07/01 UR - http://tsaco.bmj.com/content/7/1/e000977.abstract N2 - A woman in her 60s with non-insulin-dependent diabetes was found to have a CDH1 mutation from genetic workup after colectomy for sigmoid colon cancer discovered on diagnostic colonoscopy for rectal bleeding 6 years earlier. She pursued annual endoscopic surveillance until several foci of intramucosal, poorly differentiated, signet ring adenocarcinoma were found a month prior to her operation. Notably, her glucose levels were normal on outpatient checks, but her last hemoglobin A1c within the 3 months leading up to her operation was 7.4%. Her diabetes had been managed with sitagliptin-metformin 50 mg to 1000 mg two times per day, glipizide 15 mg daily, and empagliflozin 25 mg daily. She underwent an uncomplicated total gastrectomy, D2 lymphadenectomy, and Roux-en-Y esophagojejunostomy reconstruction. She progressed well postoperatively. She had no leak on an esophagogram performed with water-soluble contrast on postoperative day 2. By postoperative day 3, she was passing gas, had weaned to only oral pain medications, and advanced to her intended discharge diet of full liquids. Her diabetic medications had been held and an insulin sliding scale had been ordered with fewer than 4 units needed daily. Her point-of-care glucose levels ranged from 79 mg/dL to 201 mg/dL during this time. … ER -