Which of the following is an absolute contraindication to surgery?

• A. Hypertension
• B. Mild dehydration
• C. Nonobstructive gallstones
• D. DKA/diabetic coma

Answer: (D)

The main idea is that an absolute contraindication to elective surgery is a condition that cannot be safely corrected before the operation. Diabetic ketoacidosis or a diabetic coma creates a dangerous, unstable metabolic state with severe hyperglycemia, acidosis, dehydration, and electrolyte disturbances. Anesthesia and the stress of surgery can precipitate hemodynamic collapse, worsen acidosis, and impair wound healing. Before any elective procedure, this state must be corrected: aggressive IV fluids, careful electrolyte management (including potassium), and insulin therapy to reverse ketoacidosis, with ongoing monitoring of vitals, renal function, and electrolytes. Once the patient is stabilized and metabolic parameters normalize, surgery can be planned.

In contrast, hypertension, mild dehydration, and nonobstructive gallstones do not constitute absolute barriers to surgery; they can often be managed or corrected perioperatively, or may be incidental findings, depending on the clinical context.