Postoperative polyuria after hepatectomy associated with prolonged sodium-glucose co-transporter-2 inhibitor effect

Sodium-glucose co-transporter-2 inhibitors are routinely withheld before surgery to reduce the risk of peri-operative metabolic complications. However, their pharmacodynamic effects may persist beyond the recommended discontinuation period. We report a 67-year-old man with type 2 diabetes who developed severe postoperative polyuria (6-7 l.day^-1) with persistent glycosuria after partial hepatectomy despite discontinuation of canagliflozin 3 days before surgery. Marked transient hepatic dysfunction occurred immediately after surgery, while serum sodium remained within the normal range. Glycosuria and mild ketonuria were observed without overt ketoacidosis. Polyuria gradually resolved with supportive management including glucose-containing fluids and insulin infusion. This case suggests that postoperative hepatic dysfunction may prolong the pharmacological effects of sodium-glucose co-transporter-2 inhibitors and lead to clinically significant disturbances in fluid balance. Careful peri-operative monitoring is warranted in patients undergoing major hepatic surgery after treatment with these agents.