Overview of postoperative electrolyte abnormalities
- Nicole Siparsky, MD, FACS
Nicole Siparsky, MD, FACS
- Assistant Professor of Surgery
- Rush Medical College
- Section Editors
- Hilary Sanfey, MD
Hilary Sanfey, MD
- Section Editor — General Surgical Principles
- Professor of Surgery
- SIU School of Medicine
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
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".)
ETIOLOGIES OF POSTOPERATIVE ELECTROLYTE ABNORMALITIES
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 "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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- ETIOLOGIES OF POSTOPERATIVE ELECTROLYTE ABNORMALITIES
- Fluid therapy
- - Crystalloid fluids
- - Transfusion
- - Related to parenteral nutrition or prescription error
- Fluid loss
- - Third-spacing fluid loss
- - Gastrointestinal loss
- - Urinary loss
- Brain injury
- Related to tissue injury/ischemia and reperfusion
- Refeeding syndrome
- Acid-base imbalance
- Underlying surgical diseases and their treatment
- LABORATORY MONITORING
- Electrolyte replacement
- - Goal
- - Route
- - Amount
- - Rate
- Electrolyte excess
- SUMMARY AND RECOMMENDATIONS