However, urgent surgery for acute abdomens, for example, may not permit this to occur, and occasionally DKA will develop during surgery in a diabetic. It is therefore important for the anesthesiologist to know the principles of therapy. It is very important to remember that seldom do children die because of dehydration and shock. The usual cause of death in children with DKA is idiopathic cerebral edema. This complication may be related to the quantity or rapidity of fluid therapy, although considerable controversy exists on this matter.
Prudence therefore dictates cautious rates of rehydration.
Ongoing intraoperative blood and fluid losses should be replaced as usually done with balanced salt solutions. In general, because of the concern of cerebral edema, it is better to err on the cautious side and give too little fluid than too much fluid. It is not necessary to bolus insulin prior to initiating an infusion. In either case, glucose should continue to be monitored carefully and frequently in the operating room. Management of Diabetes in Elective Surgery Keep them sweet.