Physiological Adaptation Q 99
A patient with a history of diabetes mellitus is in the second postoperative day following cholecystectomy. She has complained of nausea and isn’t able to eat solid foods. The nurse enters the room to find the patient confused and shaky. Which of the following is the most likely explanation for the patient’s symptoms?
A. Anesthesia reaction
B. Hyperglycemia
C. Hypoglycemia
D. Diabetic ketoacidosis
Correct Answer: C. Hypoglycemia
A postoperative diabetic patient who is unable to eat is likely to be suffering from hypoglycemia. The actual treatment recommendations for a given patient should be individualized, based on diabetes classification, usual diabetes regimen, state of glycemic control, nature and extent of surgical procedure, and available expertise.
Option A: An anesthesia reaction would not occur on the second postoperative day. Anesthesia and surgery cause a stereotypical metabolic stress response that could overwhelm homeostatic mechanisms in patients with pre-existing abnormalities of glucose metabolism. The invariant features of the metabolic stress response include release of the catabolic hormones epinephrine, norepinephrine, cortisol, glucagons, and growth hormone and inhibition of insulin secretion and action.
Option B: Confusion is a late sign of hyperglycemia. Shakiness is not one of its symptoms. The management approach in these categories of patients always includes insulin therapy in combination with dextrose and potassium infusion. Major surgery is defined as one requiring general anesthesia of ?1 h. At a minimum, blood glucose should be monitored before and immediately after surgery in all patients. Those undergoing extensive procedures should have hourly glucose monitoring during and immediately following surgery.
Option D: Symptoms of DKA include excessive thirst, frequent urination, abdominal pain, fruity-scented breath, confusion, and shortness of breath. However, shakiness is not a sign of DKA. The stress of surgery itself results in metabolic perturbations that alter glucose homeostasis, and persistent hyperglycemia is a risk factor for endothelial dysfunction, postoperative sepsis, impaired wound healing, and cerebral ischemia. The stress response itself may precipitate diabetic crises (diabetic ketoacidosis [DKA].