Because of several factors, including a change in the hormonal behavior, the postoperative period is at high risk for the diabetic patient to present a metabolic complication. On the other hand, a diabetic metabolic disorder may be secondary and reveal a severe underlying complication (
sepsis...).
Ketoacidosis is the consequence of an absolute or relative lack of
insulin and occurs mainly in
insulin dependent diabetic patients. Its incidence should be very low during the postoperative period since
insulin protocols are systematically used. The main clinical and
biological signs are a polypnea, signs of
dehydration, an
hyperglycemia associated with a high anion gap
metabolic acidosis and the presence of ketoacids in the urine. Its treatment is mainly based on an active
rehydration and an
insulin and
potassium supply.
Sodium bicarbonate should not be used systematically any more, even during severe
acidosis. Hyperosmolar non ketotic states affects
insulin nondependent and older diabetic patients for the most part and occurs under similar conditions than
ketoacidosis, revealing most of the time a severe underlying complication. Clinical and
biological manifestations include a severe
dehydration, alterations in consciousness and a major
hyperglycemia associated to a moderate or mild
metabolic acidosis. Its main treatment is an active
rehydration and
insulin plus
potassium in a second time.
Hypoglycemia is usually the consequence of a mistake in the diabetes care and in the
insulin management. Every sickness or
consciousness disorder occurring in a diabetic patient treated with
insulin should lead to perform a
blood glucose measurement. In case of severe manifestations,
glucose should be administered in emergency, orally if the patient is conscious or intravenously if he is not.
Lactic acidosis occurring during the postoperative period in a diabetic patient is usually non specific of diabetic disease and reflects the existence of an underlying complication (
sepsis,
hemorrhage,
hypoxia,...), as it would in an non diabetic patient.
Lactic acidosis due to a treatment with
metformin is now very rare and occurs almost only in patients having a
contraindication to the use of
metformin.