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Administering a 5% sugar solution peri- and postoperatively usually achieves a good balance between starvation reactions and hyperglycemia caused by sympathetic activation. A 10% solution may be more appropriate when the stress response from the reaction has decreased, after approximately one day after surgery.
Initial treatment generally consists of intravenous fluids to manage dehydration, intravenous insulin in those with significant ketones, low molecular weight heparin to decrease the risk of blood clotting, and antibiotics among those in whom there are concerns of infection. [3] The goal is a slow decline in blood sugar levels. [3]
Hyperglycemia or hyperglycaemia is a condition where unusually high amount of glucose is present in blood. It is defined as blood glucose level exceeding 6.9 mmol/L (125 mg/dL ) after fasting for 8 hours and 10 mmol/L (180 mg/dL) 2 hours after eating.
Diabetic ketoacidosis may be diagnosed when the combination of hyperglycemia (high blood sugars), ketones in the blood or on urinalysis and acidosis are demonstrated. [6] In about 10% of cases the blood sugar is not significantly elevated ("euglycemic diabetic ketoacidosis"). [3] A pH measurement is performed to detect acidosis.
Hyperglycemia alters lung dendritic cell function, leading to an increase in susceptibility to respiratory agents. [44] Several studies also show diabetes associated with a worse disease course and slower recovery from respiratory infections. [45] Increased risk of wound infections; Restrictive lung disease is known to be associated with diabetes.
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Other than those listed below, common complications of TPN include hypophosphatemia, hypokalemia, hyperglycemia, hypercapnia, decreased copper and zinc levels, elevated prothrombin time (if associated with liver injury), hyperchloremic metabolic acidosis and decreased gastrointestinal motility. [8]
Hyperosmolar syndrome or diabetic hyperosmolar syndrome is a medical emergency caused by a very high blood glucose level.. The prefix "hyper-" means high, and "osmolarity" is a measure of the concentration of active particles in a solution, so the name of the syndrome simply refers to the high concentration of glucose in the blood.
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