Passmed Pearls

Question 1

Post-op ileus

Answer 1

Ileus occurs in the few days following surgery and can cause hypovolaemia and electrolyte disturbances BEFORE nausea and vomiting becomes apparent

hypovolaemic + AKI and low electrolytes–> losing salt and water in third space (+ve fluid balance)

Usually self-limiting, can cause N&V, abdo distension and tenderness

Treat with wide-bore NG tube + replacement fluids

Question 2

Potential complication of excessive NaCl

Answer 2

Hyperchloraemic acidosis
* Hartmann’s for larger volumes of fluid

Question 3

Post-op cause of new-onset atrial fibrillation

Answer 3

Anastomotic leak (day 5)

Question 4

Anaesthetic agent for haemodynamically unstable patients

Answer 4

Ketamine (preserves blood pressure)

Question 5

Preferred access for total parenteral nutrition

Answer 5

Central vein access
* cannula is too phlebitic