32.Emergency Surgery in Diabetic Patients

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

Recommended initial treatment for ketoacidosis during resuscitation phase

• 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

Recommended rate of insulin infusion for diabetic patients with ketoacidosis

• 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