|
Management of children with diabetes requiring surgery or fasting
Emergency surgery
- DKA may present as an ‘acute abdomen’
- Acute illness may precipitate DKA (with severe abdominal pain)
- Nil by mouth
- Secure IV access
- Check weight, electrolytes, glucose, blood gases and urinary ketones preoperatively
- If ketoacidosis is present, follow protocol for DKA and delay surgery until circulating volume and electrolyte deficits are corrected
- If there is no ketoacidosis, start IV fluid and insulin infusions as for elective surgery
Minor procedures requiring fasting
For short procedures (with or without sedation or anesthesia) and when rapid recovery is anticipated, a simplified protocol may be organized by experienced diabetes/anesthetic personnel and may include either
- early morning procedure (e.g. 8.00–9.00 am) with delayed insulin and food until immediately after completion
or
- reduce (e.g. give of) usual insulin dose or give repeated small doses of
short/rapid-acting insulin
Glucose 5–10% infusion and frequent BG monitoring are recommended in all these situations
|
|
|
|
|
|
