Electrolyte And Fluid Management

Question 1

Phosphate correction

Answer 1

0.5 mmol /kg
Standard in PSMMC 30 mmol in 250 ml NS

Question 2

Potassium supplements are generally withheld on the operative day, why ?

Answer 2

because a mild hyperkalemia is routinely observed after operation, due in part to release of potassium from dissected or injured tissues.5 More importantly, potassium is withheld because the status of kidney function is unknown in the first hours following operation, even when urine volume is apparently normal.

Question 3

The current recommendations are to correct the sodium not more than — - —- mEq/L per — hours to avoid what ?

Answer 3

The current recommendations are to correct the sodium not more than 8-12 mEq/L per 24 hours. To avoid central pontine myelinolysis

Question 4

●Increased water intake is required if the patient has fever, sweating, burns, tachypnea, surgical drains, polyuria, or ongoing significant gastrointestinal losses.

Answer 4

water requirements increase by 100 to 150 mL/day for each degree of body temperature elevation over 37°C.

Question 5

a reasonable approach is to begin with two liters per day of one-half isotonic saline in 5 percent dextrose to which 20 mEq (ie, 20 mmol) of potassium chloride is added per liter. This regimen provides 9 g of sodium chloride (3.4 g of sodium), which is similar to the sodium content of a hospital diet. The presence of dextrose in the solution does not alter its tonicity, and infusion of two liters of the dextrose-containing solution provides 400 kilocalories, enough to suppress catabolism. Patients with gastrointestinal or third-space losses may require a higher rate of saline (or blood) administration to maintain volume balance.

Answer 5

The original solution can be continued unless one of the following occurs:

●If the serum sodium starts to fall, a more concentrated solution should be given (eg, isotonic saline in 5 percent dextrose).
●If the serum sodium starts to rise due, for example, to increased insensible losses from high fever, a more dilute solution should be given (eg, one-quarter isotonic saline in 5 percent dextrose).
●If the serum potassium starts to fall, more potassium should be added and, should it rise above normal, potassium should be eliminated.
In patients with normal or near-normal kidney function, hyperkalemia is a rare problem.