Intraoperative severe hypoglycemia indicative of post-hepatectomy liver failure

We present the first reported case of a patient with intraoperative hypoglycemia, with no predisposing factors, that was indicative of post-hepatectomy liver failure due to liver injury. A 56-year-old man was hospitalized to undergo left lateral segmentectomy, cholecystectomy and T-tube choledocholithotripsy due to calculi in the intrahepatic and common bile ducts. His medical history was unremarkable. Three hours after surgery initiation, his glucose level decreased from 84 mg/dL to below detectable levels. We infused 20 % dextrose repeatedly until his glucose level returned to within normal limits. His aspartate aminotransferase and alanine aminotransferase levels increased to over 10,000 IU/L, and his blood urea nitrogen and creatinine levels increased postoperatively. Thus, we diagnosed post-hepatectomy liver failure and hepatorenal syndrome and treated the patient conservatively. This case illustrates that, if no other causative factors for severe hypoglycemia occurring during liver resection are present, the anesthesiologist should predict post-hepatectomy liver failure due to liver injury and inform the surgeon in order to enable rapid evaluation and treatment.