DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161972

Serum electrolyte changes in major surgical trauma

Ram Ranjan Singh, Sudhanshu Shekhar, Md. Jawed Akhtar, Vijay Shankar

Abstract


Background:Operative trauma is followed by a series of changes collectively referred to as metabolic response to injury, the magnitude and duration of the response being directly proportional to the severity of the trauma. Operative trauma imposes a great impact in the physiology of fluid and electrolytes within the body. Fluid and electrolyte management has thus been an integral part of care of each and every surgical patient. In the present study, an attempt has been made to study the electrolyte changes, especially that of sodium and potassium following surgical trauma due to various surgical procedures and its implication in the principles of replacement therapy.

Methods: The present study is being carried out in 50 surgical patients both male and female, of age group of 18-70 years. Serum electrolytes (Na, K, Cl, Ca and Mg) of each patient was estimated one day before operation (-1), on the day of operation (0) after surgery, next consecutive 4 postoperative days (+1, +2, +3, +4) and on 7th postoperative day (+7).

Results: There occur a fall in serum sodium and chloride level on the day of operation in all cases which attain a still lower level in 1st postoperative day. Then from 2nd postoperative day onwards, there occur a gradual rise and attain preoperative value by 4th postoperative day in most cases and by 7th postoperative day in all cases. There occurs an elevation on serum potassium level from the day of operation, which becomes highest in 1st postoperative day. This follows a gradual fall in from 2nd postoperative day onwards and attains preoperative level in most cases by 4th postoperative day and in all cases by 7th postoperative day. Serum calcium and serum magnesium showed a constant serum level throughout the study period.

Conclusion: There was tendency of the body to conserve sodium, chloride on the day of operation and on 1st postoperative day, while potassium is excreted from body in these days. From postoperative day onwards the trend started to attain preoperative values and completed by day 4 postoperatively. The changes in serum electrolytes were directly proportional to degree of tissue trauma or tissue handling.

 


Keywords


Trauma, Electrolytes, Potassium, Sodium

Full Text:

PDF

References


Klutts JS, Scott MG. Physiology and disorders of water, electrolyte, and acid base metabolism. Tietz Textbook of clinical chemistry and molecular diagnostics 4th ed. 1747-76.

Shires GT. Fluid and electrolyte management of the surgical patient. Schwartz's Principles of Surgery.9e:51-66.

Minto G, Biccard B. Assessment of the high-risk perioperative patient. BJA Education. 2014;14(1):12-7.

Burton D, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Contin Educ Anaesth Crit Care Pain. 2004;4(5):144-7.

Moore FD. Metabolic care of surgical patient. Philadelphia. 1959.

Surwit EA, Tam TY. Postoperative Care Glob. libr. women's med. 2008.

Piper GL, Kaplan LJ. Fluid and electrolyte management for the surgical patient. Surg Clin North Am. 2012;92(2):189-205.

Powell-Tuck J, Gosling P, Lobo DN, Allison SP, Carlson GL, Gore M, et al. British consensus guidelines on intravenous fluid therapy for adult surgical patients - GIFTASUP. 2008. Available at:www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf.

Rassam SS, Counsell DJ. Perioperative electrolyte and fluid balance continuing: education in anaesthesia, critical care and pain. 2005;5(5):157-60.

Lobo DN. Fluid, electrolytes and nutrition. Proceedings of Nutrition Society. 2004;63:453-66.

Steele A, Gowrishankar M, Abrahamson S, Mazer CD, Feldman RD, Halperin ML. Postoperative hyponatremia despite near isotonic saline infusion: a phenomenon of desalination. Ann Intern Med. 1997;126(1):20-5.

Luckey AE, Parsa CJ. Fluid and electrolytes in the aged. Arch Surg. 2003;138:1055-60.

Finnerty CC, Mabvuure NT, Ali A, Kozar RA, and Herndon DN. The surgically induced stress response. J Parenter Enteral Nutr. 2013;37(50):21S-29S.

Şimşek T, Şimşek HU, Cantürk NZ. Response to trauma and metabolic changes: posttraumatic metabolism. Turkish J Surg. 2014;30(3):153-9.

Hiner HH, Suki WN. Fluid and electrolyte disorders in surgical patient. Therapy of Renal Diseases and Related Disorders. 1991;2e:263-76.

Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109-17.

El Sharkawy AM, Sahota O, Maughan RJ, Lobo DN. The pathophysiology of fluid and electrolyte balance in the older adult surgical patient. Clinical Nutrition. 2014;33(1):6-13.

Simon PA, Lobo DN. Fluid and electrolytes in the elderly. Current Opinion in Clinical Nutrition and Metabolic Care. 2004;7(1):27-33.