32.Emergency Surgery in Diabetic Patients
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Questions and Answers

Which of the following is true about the volume of intravenously administered fluid required?

  • It ranges from 5 to 7 L
  • It ranges from 1 to 3 L
  • It ranges from 3 to 5 L (correct)
  • It ranges from 7 to 10 L

    • What is the cause of factitious hyponatremia in some cases?

  • Hyperglycemia
  • Hypertriglyceridemia
  • Both hyperglycemia and hypertriglyceridemia (correct)
  • Neither hyperglycemia nor hypertriglyceridemia

    • How much does the plasma sodium concentration decrease for every 100 mg/dL increase in plasma glucose greater than normal?

  • 0.6 mEq/L
  • 2.0 mEq/L
  • 1.6 mEq/L (correct)
  • 1.0 mEq/L

    • What is the initial rate at which balanced crystalloid solution is infused?

    <p>750 to 1000 mL/h</p> Signup and view all the answers

    How much of the estimated fluid deficit is corrected during the first 6 to 8 hours?

    <p>One third</p> Signup and view all the answers

    What determines the degree of acidosis in an acutely ill diabetic patient?

    <p>Both analysis of arterial blood gases and detection of an increased anion gap</p> Signup and view all the answers

    What is the most important electrolyte disturbance in diabetic ketoacidosis?

    <p>Depletion of total-body potassium</p> Signup and view all the answers

    What is the average phosphorus deficit in ketoacidosis?

    <p>1 mmol/kg body weight</p> Signup and view all the answers

    What happens to β-hydroxybutyrate levels after treatment with fluids and insulin?

    <p>They decrease rapidly</p> Signup and view all the answers

    What is an indication of the continued need for intracellular glucose and insulin in diabetic ketoacidosis?

    <p>Persistent ketosis with a serum bicarbonate level less than 20 mEq/L</p> Signup and view all the answers

    Which of the following is a common metabolic complication seen in diabetic patients requiring emergency surgery?

    <p>Hyperglycemia</p> Signup and view all the answers

    What is the recommended initial treatment for ketoacidosis during the resuscitation phase?

    <p>Crystalloid fluids</p> Signup and view all the answers

    How is insulin therapy initiated in diabetic patients with ketoacidosis?

    <p>Intravenous insulin infusion</p> Signup and view all the answers

    What is the recommended rate of insulin infusion for diabetic patients with ketoacidosis?

    <p>Determined by dividing the last serum glucose value by 150</p> Signup and view all the answers

    What is the maximum rate of glucose decline during insulin therapy for ketoacidosis?

    <p>Averages 75 to 100 mg/dL/h</p> Signup and view all the answers

    When should the intravenous fluid for ketoacidosis include 5% dextrose?

    <p>After serum glucose reaches 250 mg/dL</p> Signup and view all the answers

    What is the primary reason for not delaying surgery in diabetic patients with ketoacidosis?

    <p>To prevent further metabolic deterioration</p> Signup and view all the answers

    What are the potential life-threatening complications of fluid and electrolyte disturbances in diabetic patients requiring emergency surgery?

    <p>Hypokalemia and hypoglycemia</p> Signup and view all the answers

    What can help reduce the likelihood of intraoperative cardiac arrhythmias resulting from ketoacidosis in diabetic patients?

    <p>Intravascular volume depletion</p> Signup and view all the answers

    How much time is typically available to stabilize a diabetic patient requiring emergency surgery?

    <p>Several hours</p> Signup and view all the answers

    Study Notes

    Volume of intravenously administered fluid

    • The volume of intravenously administered fluid required varies depending on the individual patient's condition and fluid deficits
    • It is important to assess the patient's fluid status and consider factors such as ongoing losses, dehydration, and electrolyte imbalances

    Cause of factitious hyponatremia

    • Factitious hyponatremia can occur in some cases due to the presence of high levels of lipids or proteins in the blood, which can falsely decrease the measured sodium concentration

    Decrease in plasma sodium concentration with increased plasma glucose

    • For every 100 mg/dL increase in plasma glucose greater than normal, the plasma sodium concentration can decrease by approximately 1.6 mEq/L

    Initial rate of infusion for balanced crystalloid solution

    • The initial rate at which balanced crystalloid solution is infused can vary depending on the patient's condition, but it is typically started at a moderate rate such as 250-500 mL/hour

    Correction of estimated fluid deficit

    • During the first 6 to 8 hours of treatment, approximately half of the estimated fluid deficit is usually corrected

    Determinants of acidosis in acutely ill diabetic patients

    • In acutely ill diabetic patients, the degree of acidosis is determined by the severity of insulin deficiency, presence of ketosis, and the underlying cause of the illness

    Most important electrolyte disturbance in diabetic ketoacidosis

    • The most important electrolyte disturbance in diabetic ketoacidosis is the depletion of total body potassium

    Average phosphorus deficit in ketoacidosis

    • The average phosphorus deficit in ketoacidosis is approximately 1-2 mmol/kg

    β-hydroxybutyrate levels after treatment with fluids and insulin

    • After treatment with fluids and insulin, β-hydroxybutyrate levels usually decrease as the body shifts from a catabolic state to an anabolic state

    Indicator of continued need for intracellular glucose and insulin in ketoacidosis

    • An elevated anion gap and persistent ketosis despite treatment are indications of the continued need for intracellular glucose and insulin in ketoacidosis

    Common metabolic complication in diabetic patients requiring emergency surgery

    • A common metabolic complication seen in diabetic patients requiring emergency surgery is hyperglycemia
    • The recommended initial treatment for ketoacidosis during the resuscitation phase includes administration of intravenous fluids, correction of electrolyte imbalances, and initiation of insulin therapy

    Initiation of insulin therapy in diabetic patients with ketoacidosis

    • Insulin therapy in diabetic patients with ketoacidosis is typically initiated with a continuous intravenous infusion of regular insulin
    • The recommended rate of insulin infusion for diabetic patients with ketoacidosis is typically 0.1 units/kg/hour

    Maximum rate of glucose decline during insulin therapy for ketoacidosis

    • The maximum rate of glucose decline during insulin therapy for ketoacidosis is generally around 75-100 mg/dL per hour

    Inclusion of 5% dextrose in intravenous fluid for ketoacidosis

    • 5% dextrose is typically included in the intravenous fluid for ketoacidosis when the blood glucose level falls below a certain threshold (e.g., 250 mg/dL)

    Primary reason for not delaying surgery in diabetic patients with ketoacidosis

    • The primary reason for not delaying surgery in diabetic patients with ketoacidosis is to prevent further deterioration of the patient's condition and minimize the risk of complications

    Life-threatening complications of fluid and electrolyte disturbances in diabetic patients requiring emergency surgery

    • Potential life-threatening complications of fluid and electrolyte disturbances in diabetic patients requiring emergency surgery include cardiac arrhythmias, hypovolemic shock, and abnormalities in potassium levels

    Reduction of intraoperative cardiac arrhythmias in diabetic patients with ketoacidosis

    • Adequate fluid resuscitation, correction of electrolyte imbalances, and optimization of glycemic control can help reduce the likelihood of intraoperative cardiac arrhythmias resulting from ketoacidosis in diabetic patients

    Stabilization time for diabetic patients requiring emergency surgery

    • The amount of time available to stabilize a diabetic patient requiring emergency surgery can vary depending on the urgency of the surgical procedure and the patient's overall condition

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    Description

    Test your knowledge on emergency surgery in diabetic patients, including the management of metabolic decompensation and fluid/electrolyte disturbances. Learn about the importance of timely intervention and the potential risks of delaying surgery.

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