Key result
A 60-year-old woman undergoing exploratory laparotomy for an incarcerated and perforated umbilical hernia developed four concurrent acid-base disturbances, including starvation ketosis.
Why the study?
Not all perioperative acid-base imbalances in critically-ill surgical patients stem from tissue hypoperfusion, and other etiologies may be missed during acute surgical resuscitation.
Case Report (n=1)
Early recognition of complex acid-base imbalances, beyond just lactic acidosis, is crucial in critically ill surgical patients to accurately manage and predict their post-operative course.
Non-lactic acid-base disorders may be missed in surgical resuscitation; case report leaves open need for broader perioperative evaluation.
Lactic acidosis is common in critically-ill surgical patients, but not all perioperative acid-base imbalances are attributable to tissue hypoperfusion. Other causes of acid-base abnormalities can be missed when focused on acute resuscitation of a surgical pathology. This report presents the case of a 60-year-old woman with no past medical history who underwent exploratory laparotomy for umbilical hernia with incarcerated and perforated bowel whose perioperative management was complicated by four acid-base disturbances, including starvation ketosis. This case highlights the importance of early recognition of acid-base imbalances to explain concurrent medical pathology and accurately predict a patient's expected post-operative course.
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Mavrothalassitis et al. (2022) conducted a case report in Acid-base disturbances in a critically-ill surgical patient (n=1). Exploratory laparotomy and perioperative management was evaluated on Development of acid-base disturbances. A 60-year-old woman undergoing exploratory laparotomy for an incarcerated and perforated umbilical hernia developed four concurrent acid-base disturbances, including starvation ketosis.
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