[Verse 1] Glucose creeping in the perioperative dawn, Target one-forty to one-eighty, keep the range drawn, Hold the SGLT2 — three days before the cut, Euglycemic ketoacidosis hides the rut, GLP-1 agonists slow the stomach's churn, Aspiration lurks when gastric emptying won't turn, Insulin drips and subcutaneous sliding scales, Check the ketones when the clinical picture fails [Chorus] Alpha before beta, block the pheo first, Cortisol at stress dose quenches adrenal thirst, T3 and T4, thyroid storm will rage, Electrolytes in balance, metabolic sage, Phenoxybenzamine, then the propranolol, Steroid supplementation, never let it fall — Endocrine and metabolic, learn them one by one, The hormones run the OR before the case is done [Verse 2] Hypothyroid slows conduction, blunts the vascular tone, Hyperthyroid spikes the cardiac rate down to the bone, Cushing's rounds the face and thins the capillary wall, Acromegaly distorts the airway — video laryngoscope call, Pituitary tumors crowd the sella's narrow hall, Diabetes insipidus follows if the stalk should fall, Adrenal cortex stripped by illness, surgery, or steroid years — Supplement with hydrocortisone to quiet perioperative fears [Chorus] Alpha before beta, block the pheo first, Cortisol at stress dose quenches adrenal thirst, T3 and T4, thyroid storm will rage, Electrolytes in balance, metabolic sage, Phenoxybenzamine, then the propranolol, Steroid supplementation, never let it fall — Endocrine and metabolic, learn them one by one, The hormones run the OR before the case is done [Verse 3] Obesity reshapes the physics of the lung, Functional residual capacity wrung, Preoxygenate with ramping — head above the chest, Lean body weight for propofol, IBW for the rest, OSA lurks in every crowded Mallampati throat, VTE stockings, heparin prophylaxis — always note, Positioning pressure ulcers haunt the longer case, Rhabdomyolysis smolders when the padding's out of place [Bridge] Malnutrition, a cachexia of cellular will — Albumin cratered, wound healing standing still, Hyponatremia corrects no faster than a crawl, Hyperkalemia peaks the T-wave like a wall, Hypocalcemia tingles in the Chvostek sign, Hypomagnesemia makes the arrhythmias intertwine, Every ion has a kinesis — ordered, tidal, slow — The body's sempiternal ledger balancing below [Chorus] Alpha before beta, block the pheo first, Cortisol at stress dose quenches adrenal thirst, T3 and T4, thyroid storm will rage, Electrolytes in balance, metabolic sage, Phenoxybenzamine, then the propranolol, Steroid supplementation, never let it fall — Endocrine and metabolic, learn them one by one, The hormones run the OR before the case is done [Outro] Sempiternal — ever-present, always cycling through, Kinesis — motion in the ions shifting in you, Check the glucose, check the cortisol, ask about the pheo, Every gland a quiet architect of everything we know
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