Es No Preop Cho Fluids

---
name: es-no-preop-cho-fluids
description: Do not administer carbohydrate-containing oral fluids preoperatively to adult patients with diabetes undergoing planned elective surgical procedures. Triggered when clinicians ask, "Should we give this patient a carbohydrate drink before surgery?"
---

# Avoid administering carbohydrate-containing oral fluids preoperatively

## STEP 1 — Gather Information
Confirm diabetes diagnosis (type 1, type 2, or other), verify elective surgical procedure, check current point-of-care glucose, review NPO status, and note any existing orders for preoperative carbohydrate-containing drinks. Document findings.

## STEP 2 — Rule In / Rule Out
Rule in if the patient is an adult with diabetes scheduled for elective surgery; rule out if the patient is experiencing symptomatic hypoglycemia requiring immediate carbohydrate treatment (manage per hypoglycemia protocol and reassess). Proceed to classification if ruled in.

## STEP 3 — Classify or Stratify
Classify the patient as requiring avoidance of carbohydrate-containing oral fluids preoperatively; prescribe only noncaloric fluids (e.g., water, clear tea, black coffee) if oral intake is permitted. Decide on fluid type based on this classification.

## STEP 4 — Decide
Do not administer carbohydrate-containing oral fluids; provide allowed noncaloric beverages, document the decision in the chart, and inform the anesthesia and nursing teams. Execute the plan.

## Clinical Guardrails / Mimics / Pitfalls
Do not give juice, sports drinks, soda, or any carbohydrate-containing clear liquids even if the patient reports hunger or thirst; avoid substituting with high-glycemic-index foods; be aware that inadvertent carbohydrate load can cause hyperglycemia leading to surgery cancellation; treat documented hypoglycemia with rapid-acting glucose per protocol, not routine carbohydrate drinks; ensure patient understands NPO guidelines and recheck glucose if any unintended intake occurs.

## Concrete Clinical Example
A 58‑year‑old woman with type 2 diabetes scheduled for elective colon resection asks if she can have a carbohydrate drink the morning of surgery. The team confirms diabetes and elective status, rules out hypoglycemia, classifies her as needing avoidance of carbohydrate fluids, and decides to give only water; her preoperative glucose is 110 mg/dL and surgery proceeds as planned.

**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278