Perioperative Diabetes Medications — RACP Adult Medicine MCQ
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Correct answer: D — Omit empagliflozin for two days preoperatively and surgery day; continue metformin through the preceding evening
Explanation lettering: E = shown as B · B = shown as E
D is correct. For surgery requiring hospital admission, Australian guidance withholds an SGLT2 inhibitor for two days before and on the day of surgery—three calendar days without doses—whereas other non-insulin agents may continue through the preceding night and are omitted on the day. E leaves perioperative euglycaemic DKA risk. A creates unnecessary interruption and unmonitored insulin risk. B exposes the fasting patient to both SGLT2-associated ketosis and other medication complications. C denies the defining possibility of euglycaemic DKA. Blood glucose and ketones are checked perioperatively, and empagliflozin is restarted only once the patient is clinically stable with adequate oral intake and no ketosis.
Reference: Australian Diabetes Society and ANZCA: Perioperative diabetes and hyperglycaemia guidelines: https://www.diabetessociety.com.au/guideline/ads-anzca-perioperative-diabetes-and-hyperglycaemia-guidelines-adults-november-2022/ Australian Diabetes Society: Periprocedural DKA with SGLT2 inhibitors: https://www.diabetessociety.com.au/guideline/https-www-diabetessociety-com-au-wp-content-uploads-2023-05-ads-adea-anzca-nzssd_dka_sglt2i_alert_ver-may-2023-pdf/ Australian RACP: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination