Perioperative electrolyte and fluid balance

Abstract

Appropriate fluid therapy is essential to protect organ function in the perioperative period. The physiological principles of fluid and electrolyte management are well described but a gap exists between knowledge and clinical practice. In this article, we will review fluid and electrolyte physiology, the stress response to surgery and hypovolaemia, and the consequences of electrolyte disturbances.

Haematological and serum electrolyte responses in goats undergoing tibial fracture reduction

“…Similar changes in these parameters have been previously reported in dogs that underwent femorotibial joint surgery (Sibanda et al, 2006). The catabolic phase following trauma is characterized by increased anti-diuretic hormone and aldosterone secretion with consequent water and salt retention (Rassam & Counsell., 2005;Lobo et al, 2013). This causes the expansion of the extracellular fluid leading to haemodilution and drop in haematocrit (Lobo et al, 2013).…”

“…However, apart from the fall in K+, Na+, venous gas analysis performed during this study showed that pH, PaCO 2 , HCO 3 -and base excess significantly increased in the perioperative period. These findings suggested a state of metabolic alkalosis (Pettifer, 2003;Rassam & Counsell, 2005). It has been established that the body tries to control alkalosis through buffering as well as by respiratory compensatory mechanisms.…”

“…Thus, the increase in BUN noted might be due to increased protein catabolism and decreased GFR. An important response to anaesthesia and surgery in the perioperative period is sodium and water retention in the interstitial space (Rassam & Counsell, 2005;Singh, 2003). The net effect is reduction in plasma concentration of Na+ and increase in plasma concentration of K+.…”

“…These changes occur in the body's attempt to maintain homeostasis as well as increase the rate of catabolism (Desborough, 2000;Lobo et al, 2013). In addition to the neuroendocrine and metabolic changes, acid-base and electrolyte status of animals are also altered perioperatively (Andersen & Wang, 2000;Rassam & Counsell, 2005;Kwak et al, 2010). Traumatic injuries such as fractures and their causative agents have been reported in small ruminants (Adeyanju et al, 2004;Udegbunam et al, 2009a).…”

Biochemical derangements prior to emergency laparotomy at Queen Elizabeth Central Hospital, Blantyre, Malawi: A cross-sectional pilot study

“…These derangements can result in anorexia, nausea, muscle weakness, paralytic ileus, and cardiac conduction abnormalities, all or any of which can contribute to increased postoperative morbidity and mortality. 3 Once identified, derangements, such as hypokalaemia and hypocalcaemia are readily corrected with supplementation. The cases of hyperkalaemia observed were mild, but without routine testing, severe hyperkalaemia (> 7 mmol/L) cases, leading to life-threatening cardiac arrhythmias, may be missed.…”