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A 62 year old female was admitted to the hospital for elective, two-stage spinal surgery. She had a history of type 2 diabetes mellitus, hypertension, anemia, subclinical hypothyroidism, mild mental retardation, Ogilvie's syndrome and a compression fracture of her thoracic spine; she had a history of multiple past episodes of ileus, requiring hospitalizations. Following the initial, posterior procedure, the patient was kept intubated for stage 2, an anterior approach on postoperative day (POD) 3. After this second surgery, the patient developed episodic hypotension and hypoxemia, associated with anemia and a host of metabolic derangements (hyponatremia, hypokalemia, marked hypoalbuminemia and a labile serum glucose).