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Overview of postoperative electrolyte abnormalities

Nicole Siparsky, MD, FACS
Section Editors
Hilary Sanfey, MD
Richard H Sterns, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Postoperative surgery patients are prone to electrolyte derangements related to the loss of blood and bodily fluids, the stress response to surgery, intravenous fluid administration, blood transfusion, and the underlying surgical disease.

The etiology, evaluation, and management of common electrolyte abnormalities following surgery are reviewed here. The estimation of fluid losses and correction of fluid volume deficits following surgery are discussed separately. (See "Overview of postoperative fluid therapy in adults".)


Fluid therapy — Electrolyte abnormalities observed in the postoperative period often result from the administration of intravenous fluids, fluid shifts, transfusion, and parenteral nutritional support (when indicated). (See "Overview of postoperative fluid therapy in adults" and "Preoperative evaluation and perioperative strategies to minimize blood transfusion" and "Postoperative parenteral nutrition".)

Crystalloid fluids — A variety of crystalloids are used in fluid resuscitation after surgery, including 0.9% sodium chloride, Lactated Ringer's (LR) solution, and balanced salt solutions such as Plasma-Lyte (table 1).

Although the sodium concentration of 0.9% saline (154 mEq/L) is higher than the normal plasma sodium concentration, it equals the sodium concentration of the aqueous phase of plasma, which is the phase that is in osmotic equilibrium with the rest of body fluids. However, the chloride concentration of 0.9% saline is much higher than that of plasma because the solution contains no bicarbonate.

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Literature review current through: Nov 2017. | This topic last updated: Sep 29, 2016.
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