Anesthetic Management of Endocrinal Emergencies

Abstract

Endocrine emergencies are one of most important challenges in anesthetic practice. They include: 1. Diabetes mellitus emergencies a) Diabetic ketoacidosis Characterized by hyperglycemia, ketosis and acidosis as a result of reduction of insulin causing glycemic control disturbance. It occurs in type 1D.M; manifested by polyuria, polydipsia, dehydration, Kussmaul breathing with acetone odour and disturbance of consciousness up to coma. Management include fluid replacement, insulin therapy with care to potassium monitoring, carbohydrate may be needed. Strict monitoring of blood glucose, electrolytes and blood gases is required.

b) Hyperglycemic hyperosmolar state Characterized by hyperglycemia, hyperosmolarity but without ketacedosis. It occurs in type 2 D.M. Management includes fluid replacement (0.45% saline), insulin therapy with monitoring of blood glucose, electrolytes and blood gases.

c) Hypoglycemia Decreased blood glucose level below normal range due to over dose of insulin or oral hypoglycemic drugs. Clinically patients present with sweating, fatigue, confusion, behavioral changes, seizures and coma. Signs include pallor, tachycardia, hypertension and hypothermia. Management by glucose administration orally if conscious or intravenous if comatosed. Perioperative management of diabetic patients The general principle is to maintain patient euglycemic as much as possible as this will decrease complications. It can be achieved by strict monitoring of blood glucose and insulin therapy by insulin infusion guided by sliding scale. Good anesthetic management by good analgesia, regional blocks and measures that decrease stress response will also maintain patient euglycemic.