Postoperative Diabetic Ketoacidosis

Two case presentations of diabetic ketoacidosis in postoperative orthopaedic patients with different aetiologies.

Transcript

1. AB + RT Two cases of postop DKA
2. AB ˁ 24 DM1 T12 + L3 + Left distal femur + Right patella #s Humulog 22u TDS + Lantus 18u ON Admitted 6th 7th 8th 9th 10th 11th 12th 13th Spinal fixation Left femur exfix Operation D/C HDU Left femur IM nail ORIF Right Patella Removal Left femur exfix Operation On Insulin Sliding Scale Started SC insulin UNWELL Comments DKA ℞ • No long acting insulin given night before sliding scale stopped. • Failed to anticipate increased insulin requirements from trauma hx. • Delay in diagnosis → urine not dipped for Ketones until 18:00. • Relatively modest hyperglycaemia: BM only 18.4. • Delay in treatment → insulin initially running at 0.7 units/hr cf. 7 units/hr. • Underwent CT Abdo/Pelvis for abdo pain: inappropriate? February 2012
3. RT ˂ 38 DM1 Bimalleolar left ankle # Hypurin Porcine Isophane + Neutral BD 3rd 6th 7th 16th 17th 18th 19th 20th Comments • DKA recognised over w/e but undertreated. • Confusion over insulin ‘allergy’ status. • Very high insulin requirements (14 units/hr) to suppress ketogenesis. Admitted Operation ORIF Left Ankle DKA No Rx started ITU Urosepsis Started IV Gent + Clarithro ↓BM + Fall Sustained # from hypo February 2012
4. Learning Points DKA is the medical cause of abdo pain - AB + RT both had abdo pain. Always check the urine for ketones in unwell DM1 patients Infection and trauma will increase insulin requirements Glucose does not need to be that high for DKA National guidelines are available for DKA resuscitation
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