Perioperative: diabetic drugs: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Perioperative: diabetic drugs

Sample item

A 55-year-old man with type 2 diabetes on dapagliflozin and metformin is booked for major elective surgery. Dapagliflozin is advised to be stopped at least 3 days beforehand. What complication is this intended to prevent?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Euglycaemic diabetic ketoacidosis

SGLT2 inhibitors cause glycosuria and promote lipolysis and ketogenesis. During fasting and surgical stress, this can cause diabetic ketoacidosis with near-normal blood glucose, which is easily missed. Stopping the drug about 3 days before major surgery reduces the risk. Metformin may be withheld on the day of surgery, particularly if contrast or renal impairment is expected.

Option by option

  • A. Euglycaemic diabetic ketoacidosis (correct)

    Ketoacidosis with normal glucose is the specific perioperative hazard of SGLT2 inhibitors.

  • B. Hyperkalaemia

    Hyperkalaemia is not the recognised perioperative hazard of this drug class.

  • C. Severe hypoglycaemia

    Hypoglycaemia is a risk of insulin and sulfonylureas, rarely with SGLT2 inhibitors alone.

  • D. Lactic acidosis

    Lactic acidosis is the rare risk with metformin, not with SGLT2 inhibitors.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Euglycaemic diabetic ketoacidosis. SGLT2 inhibitors cause glycosuria and promote lipolysis and ketogenesis.

Why is "Hyperkalaemia" not the answer?

Hyperkalaemia is not the recognised perioperative hazard of this drug class.

Why is "Severe hypoglycaemia" not the answer?

Hypoglycaemia is a risk of insulin and sulfonylureas, rarely with SGLT2 inhibitors alone.

Why is "Lactic acidosis" not the answer?

Lactic acidosis is the rare risk with metformin, not with SGLT2 inhibitors.

What concept does this question test?

It tests Perioperative: diabetic drugs in General Surgery. During fasting and surgical stress, this can cause diabetic ketoacidosis with near-normal blood glucose, which is easily missed. Stopping the drug about 3 days before major surgery reduces the risk. Metformin may be withheld on the day of surgery, particularly if contrast or renal impairment is expected.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Perioperative: diabetic drugs?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.