Routine labs for diabetic endoscopy patients?

[caligas]

recent chemistry for ALL diabetics or only for history of renal impairment, etc?

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[deleted697535]

Elimination of preoperative testing in ambulatory surgery.
Anesthesia and Analgesia 2009;

Neither. Unless very crocked. Every trust will have it's own local guideline though. Check that prob best

 

[Planktonmd]

recent chemistry for ALL diabetics or only for history of renal impairment, etc?

I don't think you need any labs for an endoscopy procedure.

 

[pjl]

We do just a glucose.


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[aneftp]

What about dialysis patients?

U guys check potassium level day of surgery. At high volume endo center. One year alone I had 4 patients with potassium above 6.0.

 

[risnwb]

We check a potassium on every dialysis patient pre op regardless of procedure acuity. No other routine labs are recommended for endoscopy


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[aneftp]

We check a potassium on every dialysis patient pre op regardless of procedure acuity. No other routine labs are recommended for endoscopy


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That's why I ask.

Cause gi docs see "elimination of all labs". U betcha they will want to book those dialysis patients.

Hmm. Reflux. Seen in office Wednesday. Endo center doesn't have istat. Book Thursday morning as add on egd.

"Hey we just go by ur guidelines no labs needed".

 

[anbuitachi]

Usually nothing. Occasionally glucose.

K for pretty much every dialysis patient

 

[Planktonmd]

Here is the dilemma: you check potassium on a dialysis patient who had dialysis yesterday and now it is 5.9, what are you going to do before his colonoscopy?

 

[nimbus]

Here is the dilemma: you check potassium on a dialysis patient who had dialysis yesterday and now it is 5.9, what are you going to do before his colonoscopy?

Proceed

 

[aneftp]

Here is the dilemma: you check potassium on a dialysis patient who had dialysis yesterday and now it is 5.9, what are you going to do before his colonoscopy?

This is where policy needs to be written. While we all know dialysis patients can tolerate "chronic hyperkalemia". One hospital I worked at where the vascular surgeon did 12-16 AV grafts/fistula a day (he for two rooms along with surgical PA to close). Written policy was 6.0

The days of the wild Wild West. 5.9 "proceed" you will be hosed in court. My colleague was already asked to review a case for outpatient hernia (intraop MI) cardiac arrests/brain injury. Renal patient has K 5.7 preop. Obviously patient had other co morbidly but focus is shifting to "high potassium". Center has no policy.

Set policy at the center. I don't care if it's 5.5. Or if it's 6.0. Set it. You will thank yourself in the future if a malpractice case ever arises. The lawyers will be all over you for going with an elective procedure even as benign as outpatient gi with a potassium of 5.9. But if you have written policy. You got a better let to stand on.

 

[anbuitachi]

Agreed with above. There has to be a department policy, otherwise not only will it be an issue in malpractice, you'll spend your days arguing with the surgeon when you can just say it's department policy to not do case if above X.

If really concerned, get a EKG and document no peaked T waves.

 

[fakin' the funk]

recent chemistry for ALL diabetics or only for history of renal impairment, etc?

Only even considering for ESRD. DM immaterial, assuming pt asymptomatic.

At outpatient centers I've worked at, if ESRD pt is up to date on HD and doesn't typically have K+ issues, then no day-of is required.

 

[sigrhoillusion]

Agreed with above. There has to be a department policy, otherwise not only will it be an issue in malpractice, you'll spend your days arguing with the surgeon when you can just say it's department policy to not do case if above X.

If really concerned, get a EKG and document no peaked T waves.

Also, with department policy, you never have to be put in a position where a surgeon goes well Dr. XYZ doesn't care about the K+! If you have some people that do it and some that don't then you'll be getting into arguments every week with surgeons. And if the surgeon is unhappy then tell them to write in a note why the case needs to happen right now.