Endocrine Abstracts

Objectives: To analyze the most frequent consultations on patients admitted to Orthopedic Surgery and Traumatology (OST) unit asked to medical physicians.

Material and methods: Descriptive analysis of consultations on patients admitted to OST who suffered any medical decompensation that needed to be notified.

Results: From June 2008 to November 2014, 1486 consultations were sent from OST to a medical team (Internal Medicine+Cardiology+Endocrinology+Pneumology+Nephrology) assigned to control of medical pathologies in surgical areas. The most common consultations were: dyspnea 371 (25%), pluripathology control 163 (11%), diabetes control 124 (8.3%) and high blood pressure 123 (8.3%). Digestive pathology was 10.5% (specified according to the disease: diarrhea, nausea-vomiting or abdominal pain). Analytic alterations 4%. Dyspnea was analized as it was considered too nonspecific. 48.7% were of respiratory origin: pneumonia (32%, of which 56% nosocomial), noncondensing respiratory infection (26%), exacerbation of COPD (18%), bronchospasm (16%) and pulmonary thromboembolism (2%). 41% of dyspnea had a cardiological origin; 66% the main factor inducing heart failure was not clearly identified; 13.6% presented excessive intravenous fluid therapy, 11.3% anemia secondary to the intervention, 11.3% uncontrolled atrial fibrillation. Then anxiety (4.7%). In 3,7% no dyspnea was observed. The reason for consultation was poorly controlled DM in 124 patients (8.3%), with 111 patients (89.5%) presenting hyperglycemia and 13 (10.5%) presenting hypoglycaemia. However, since the consultations were made by the Orthopedic Surgeon who requested it, after the initial evaluation of all these patients, the diagnosis of poorly controlled DM was only considered in 108 patients (7.4% of the total decompensated patients), since the rest, despite presenting glycemia above 125 on fasting, were considered controlled taking into account their particular clinical situation. This implies an actual decompensation of 24.7% of patients with known DM.

Conclusions: 25% of consultations for medical decompensation in OST patients correspond to dyspnea, almost half from respiratory origin and somewhat less from cardiological. An important percentage are due to intrahospital processes (nosocomial pneumonia and excessive intravenous therapy). DM is a cause of medical decompensation in 7.4% of patients admitted to OST. One in four known diabetics had abnormal blood glucose levels. An early examination of patients with personal history of medical problems such as diabetes, performed before the surgery, could be beneficial in terms of morbidity.