Final answer:
A 20% dextrose concentration in intraoperative maintenance fluids is typically associated with hyperglycemia. High concentrations of dextrose can cause blood glucose levels to rise due to the excess glucose provided and metabolic changes during surgery that impair insulin action.
Step-by-step explanation:
The concentration of dextrose in intraoperative maintenance fluids associated with hyperglycemia is typically higher concentrations like Option 4: 20% dextrose. Intravenous fluids with high concentrations of dextrose can lead to an elevated blood glucose level because they provide an excessive amount of glucose that can exceed the patient’s ability to utilize or store it, particularly under surgical stress where insulin sensitivity might be reduced. Surgical stress can lead to metabolic changes that impair insulin secretion and action, resulting in an inadequate utilization of glucose and subsequent hyperglycemia.
Mechanisms contributing to hyperglycemia with high dextrose concentration include an increase in counter-regulatory hormones such as glucagon, epinephrine, cortisol, and growth hormone during surgery. These hormones oppose insulin’s effects and can lead to insulin resistance, promoting hepatic glucose production and inhibiting peripheral glucose uptake. Thus, the administration of fluids with high concentrations of dextrose can compound these effects, leading to significant hyperglycemia.