Abstract
Diabetes in surgical setting, in all the complex aspects of both, has not been covered as a separate chapter in major textbooks on diabetes [1]. The information on the concomitantly present myriad aspects have remained scattered in the textbooks on surgery, anesthesia, or ICU protocols. All major textbooks on medicine have provided less than meager space for diabetes. As a result, the plethora of issues arising for the three major contributors, surgeons, physicians, and anesthetists have not been satisfactorily answered to conduct safe surgery and splendid recovery. A cohesive, comprehensive, and not ad hoc approach towards resolution of these difficulties has not been available. The iatrogenic issues that arise when multiple specialties must collaborate, agree upon certain matters, and take joint responsibility have never been discussed. This has led to fragmentation of care which cannot be more detrimental than in managing patients with diabetes undergoing major, acute, or critical surgical situations than in any other. This volume is one such effort to ease the situation.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Potential adverse effects of bicarbonate infusions are – overshoot alkalosis, paradoxical cerebrospinal fluid acidosis, hypokalemia, volume overload alteration in tissue oxygenation and overproduction of ketoacids.
- 2.
Under outpatient care if potassium and creatinine levels are estimated when the patient is on ACEI or ARBs, it is not uncommon to find potassium levels as high as 6 mmol or more. However it does not seem to cause much discomfort, notwithstanding that these levels must be lowered to acceptable levels like 4.5 mmol. Potassium-sparing diuretics must be discontinued first, with fruit juices and other potassium-containing fluids or food (e.g., urinary alkalinizers) and putting these patients on loop diuretics in high doses or urgent dialysis as necessary.
References
Joslin EP. Joslin’s textbook of diabetes mellitus. 14th ed. Boston, MA: Lippincott, Williams & Wilkins; 2005, Indian edition.
Trence DL, Hirsch IB. Hyperglycemic crisis in diabetes mellitus type 2. Endocrinol Metabol Clin North Am. 2001;30(4):817.
Morales AE, Rosenbloom AI. Deaths caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes. J Pediatr. 2004;144:270–3.
Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC. Electrocardiographic manifestations: electrolyte abnormalities. J Emerg Med. 2004;27(2):153–60.
El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol J. 2011;18(3):233–45.
Milaskiewicz RM, Hall GM. Diabetes and anesthesia: the past decade. Br J Anesth. 1992;68:198–206.
Nugent BW. Hyperosmolar hyperglycemic state. Emerg Med Clin North Am. 2005;23:629–48.
American Diabetes Association. Hyperglycemic crisis in diabetes. Diabetes Care. 2004;27(Suppl 1):S94–102.
Chiasson J, Aris Jilwan N, Belanger R, et al. Diagnosis and treatment of diabetic ketoacidosis and hyperglycemic hyperosmolar state. Can Med Assoc J. 2003;168(7):859–66.
Umipierrez GE, Khajavi M, Kitabchi AE. Review: diabetic ketoacidosis and hyperglycemic hyperosmolar non ketotic syndrome. Am J Med Sci. 1996;311:225–33.
Launder M, Hammer D, Kelen GD.. Fluid and electrolyte problems In: Tintaneli JE, editor. Emergency medicine a comprehensive study guide. New York, NY: McGraw-Hill; 2004. p. 167–79.
Hitler TA, Abbott D, Barret EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1299;106:399–403.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kelkar, S., Muley, S., Ambardekar, P. (2019). Perioperative Diabetic Emergencies. In: Towards Optimal Management of Diabetes in Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-7705-1_2
Download citation
DOI: https://doi.org/10.1007/978-981-13-7705-1_2
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-7704-4
Online ISBN: 978-981-13-7705-1
eBook Packages: MedicineMedicine (R0)