Pre-operative management of a patient with tubo-ovarian abscess and diabetic ketoacidosis

Abstract

Background: Diabetic ketoacidosis (DKA) is a serious consequence of uncontrolled diabetes, especially in patients complicated by certain infections. Patients with DKA often require surgery; however, at the same time are more vulnerable to unintended postoperative complications. Therefore, proper pre-operative management in these patients is prominent. This study aimed to summarize pre-operative management of a patient with DKA and tubo-ovarian abscess. Case Presentation: A 45-year-old female was referred to Dr. Soetomo Hospital Surabaya with a chief complaint of fever, right abdominal pain, and white vaginal discharge. The patient had a history of uncontrolled DM since 2014. Ultrasonography examination revealed the presence of a hyperechoic mass in the uterine fundus (size: 6,39 x 7,36 cm). Initial laboratory examination indicated leukocytosis, hyperglycemia, hyponatremia, proteinuria, and ketoacidosis condition. The patient was diagnosed with DKA, type 2 diabetes mellitus (T2DM), tubo-ovarian abscess. Before undergoing surgery to remove the abscess, the patient received fluid therapy (NaCl 0,9%); insulin therapy (rapid-acting insulin 2x4 IU intravenous (IV), bicarbonate 100 mEq in 400 mL normal saline/24 hours IV, and rapid-acting insulin pump 1 IU/hour); diet therapy, and antibiotic therapy (ampicillin 1 gr every 6 hours IV, gentamycin 240 mg every 24 hours IV, and metronidazole 500 mg every 8 hours IV). Regular examination was performed, which included the evaluation of random blood glucose (RBG) every 3 hours, serum electrolytes every 24 hours, repeat blood gas analysis every 24 hours, blood culture, and vaginal swabs. Conclusion: Euglycemia is the main goal of perioperative treatment in order to enhance postoperative results. Careful blood glucose management should be performed before surgery to decrease patients' morbidity and mortality. It must also be highlighted that regular patient monitoring through clinical and laboratory markers is essential to treat DKA successfully.