Diabetic + Steroid Patients Flashcards
What are the signs of hypoglycaemia?
Tired Dizziness Hungry Shaking Trembling
What happens to signs of hypoglycaemia under GA?
They are masked
But can check blood glucose
What is the consequence of hypoglycaemia under GA?
Permanent brain injury
What is the target range for intraoperative blood glucose?
6-10 mmol/L
Below what intraoperative blood glucose level and above which level is intervention required?
Below 4 mmol/L
Above 12 mmol/L
Why is aspiration of gastric contents into respiratory tract so dangerous?
Acid can irritate/block airways which compromises airflow - aspiration pneumonia which can cause lung abscess, chronic interstitial fibrosis
What are the indications for variable rate insulin infusion (VRII)?
Pts anticipated to have long starvation period ( 2 or more missed meal)
Decompensated or poorly controlled diabetes
Which patients are more likely to have HPA axis suppression?
Those who receive high doses (>20-30mg prednisolone or equivalent) of systemic steroids for long periods (3 weeks) and those who appear to have cushingoid features.
What are cushingoid features?
Thinning of skin Weakness Weight gain - central obesity Bruising Hypertension Dorsoclavicualar fat pad Moon face Purple straie
What do steroids do in relative to GI pathology?
Steroids mask symptoms of GI pathology
What may happen if steroids are suddenly stopped before surgery?
Addisionian crisis
What are the clinical features of addisonians crisis?
N/V Hypoglycaemia Hypotension Fever Hyperkalemia Hyponaturemia
What is a common regime used in intraoperative and post operative phase for pts on steroids?
25mg IV hydrocortisone 4 times a day
