[Transient hyperglycemia following intra-peritoneal irrigation with 5% glucose in a patient with pseudomyxoma peritonei].
Pseudomyxoma peritonei is a condition characterized by the production of a large amount of mucopolysaccharide by a neoplastic epithelium. Although surgical removal of the mucinous ascites may be attempted, complete removal of the material is difficult. Thus, intra-peritoneal lavage with the liquid containing glucose or dextrose has been advocated to prevent reaccumulation of the mucus and complications such as bowel obstruction requiring repeated surgery. We report a case showing transient hyperglycemia following intra-peritoneal irrigation with 5% glucose in a patient with psudomyxoma peritonei. The patient was a 72-year-old woman. Preoperatively, she had hypertension and angina pectoris; but no history of glucose intolerance. Serum glucose was 92 mg x dl(-1). General anesthesia was induced with propofol (100 mg), vecuronium (6 mg), and fentanyl, and maintained with oxygen (33%), nitrous oxide and sevoflurane (1-2%). A mucinous tumor was found with a great deal of mucinous ascites. To remove the mucus and prevent subsequent re-accumulation, intra-peritoneal irrigation with 5% glucose in water was performed. Shortly after this procedure, the patient was found to be hyperglycemic (serum glucose 266 mg x dl(-1)) with normal oxygenation and hemodynamic data. The patient recovered uneventfully and could be extubated soon after surgery. Serum glucose level returned to 154 mg x dl(-1) one hour after surgery. Therefore, we think that this acute hyperglycemic condition, presumable due to intra-peritoneal irrigation, was transient. It is important to be aware of this dangerous complication associated with intra-peritoneal glucose instillation. Glucose monitoring during and after irrigation with glucose or dextrose is recommended.
Mieda
Rie
R
Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi City 371-8511, Japan.
Aso
Chizu
C
Nishikawa
Koichi
K
Saito
Shigeru
S
Goto
Fumio
F
D000368:Aged; D000768:Anesthesia, General; D001786:Blood Glucose; D005260:Female; D005947:Glucose / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D008991:Monitoring, Physiologic; D010533:Peritoneal Lavage / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D011553:Pseudomyxoma Peritonei / Q000601:surgery*
D001786:Blood Glucose; D005947:Glucose