Impact of diabetes mellitus and metabolic disorders.

Metabolic and endocrine disorders are common in the perioperative surgical patient. During surgical stress and critical illness, each hormonal system reveals characteristic changes that can be of diagnostic and prognostic significance. A number of endocrinopathies,electrolyte problems, or metabolic derangements may either preexist or develop during the course of surgical treatment. Early correction and tight control of blood glucose levels was shown to improve outcome in critically ill surgical patients. However, many other pharmacological interventions to correct endocrine alterations in critical illness have proven unsuccessful, most likely because of the many overlapping actions between the endocrine and immune systems, and are not standard of care in surgical patients.