A 42-year-old woman with diabetes mellitus type 2 treated with the sodium-glucose cotransporter-2 inhibitor canagliflozin underwent elective bariatric gastric bypass. The canagliflozin was held for 24 hours preoperatively. She physiologically decompensated on postoperative day 2. Ultimately, she was diagnosed with euglycemic diabetic ketoacidosis that required intensive care management. This diagnosis was challenging to make as the patient never became hyperglycemic. We use this case to discuss the pharmacology and potential risk of perioperative sodium glucose cotransporter-2 inhibitor administration and to advocate for revision of current guidelines regarding the perioperative management of these agents.
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A significant minority of patients receiving RT were successfully extubated. Higher radiation doses were predictive of improved OS and showed a trend for increased ES. Survival beyond 6 months was uncommon, however, the majority of patients with ES were able to be discharged home.
improvement perceived. Acute toxicities, in fact, can worsen the clinical condition especially when receiving MV and also reduces the quality of life. We would like to know whether the authors would have considered any pre-and post-RT pulmonary assessment/function studies. In this study, the authors do not provide information on acute cardiopulmonary toxicities related to RT. 4 Third, we would like the authors to comment on any variables they had noted or would have preferred to measure that could predict the risk of toxicity and outcome in their patient population. Fourth, although a small number of patients were successfully extubated and discharged out of intensive care unit and hospital, it would have been useful to understand their quality of life, performance scores, and ability to perform activities of daily living. This may shift the focus from extubation from MV to postextubation meaningful lifestyle. Finally, information on endof-life care issues in their patient population and mode of MV, such as single lung versus double lung, pressure cycled versus volume cycled, and standard versus high-frequency ventilation, would have addressed some practical issues for clinicians and intensivist. 5 We believe that further clinical studies will provide more understanding of the role of RT in MAO requiring MV. This study has indeed paved the way to this understanding and we would like to commend the authors for this work.
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