Abstract
In the postoperative period, many different situations arise in which for fear of hypoglycemia, the blood glucose is allowed to remain higher. There are situations which could however lead to hypoglycemia which need to be appreciated. Majority of these will arise on account of the quality of care and operationalizing the instructions. More important however is to monitor care closely enough and be aware of what could go astray due to the multiple measures of management undertaken and the potential not only for hypoglycemia but also for hyperglycemic swings.
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Notes
- 1.
To illustrate—We had a male patient 65 years of age, with diabetes who was diagnosed to have a massive streptococcal bacterial pneumonia, was put on insulin and intravenous antibiotics (the symptoms resolved quickly even when the radiographic changes remained), and was sent home on split-mix insulin twice a day. On the seventh day after discharge, he was admitted with severe hypoglycemia. The radiological recovery was complete and diet as well as insulin regime was maintained well. This is how infection and its resolution play a role in controlling glucose or in producing hypoglycemia.
- 2.
To illustrate—A middle-aged woman whose preoperative investigations did not show any abnormality was operated for a large abscess on the back under GA who remained drowsy for an unduly long period. Upon checking her thyroxine levels done a few months ago, it was normal but was revealed that she had for some reason discontinued the tablets after that.
In another and rather remarkable case, a stable fit-to-operate young man underwent closed mitral valvotomy and was otherwise stable but grossly hypotensive after surgery. On exploring it was revealed that prior to the operation, he was treated for fairly extensive pulmonary tuberculosis and was fully cured prior to operation. A random sample of blood for cortisol was drawn, and cortisol was started without waiting for the results with dramatic improvement in the blood pressure. The reasoning given was an occult tubercular adrenalitis which had left it suboptimal in response. The cortisol level was found to be lowest normal, which under the serious operative stress was considered hypoadrenal response.
- 3.
An acutely hypoglycemic brain produces bizarre EEG wave patterns. For the EEG waves to normalize, it takes no more than 22–25 s even with a 5% dextrose drip much before full recovery of cognition in minutes to follow. In investigating a case of excessive morning drowsiness suspected of malingering, we strapped the patient to an EEG machine and did his blood glucose which was 20 mg/dL. After the first waveforms were recorded, we started a glucose 5% dextrose drip at 100 mils/h. The EEG normalized in 25 s and recovery of consciousness within minutes. This patient was later diagnosed as having insulinoma.
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Kelkar, S., Muley, S., Ambardekar, P. (2019). Hypoglycemia in Postoperative Setting. In: Towards Optimal Management of Diabetes in Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-7705-1_5
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