Hypophosphataemia: A complication of "innocuous dextrose-saline"

Area of Science:

• Biochemistry
• Clinical Medicine
• Surgical Care

Background:

• Postoperative fluid management is critical for patient recovery.
• Intravenous fluid composition can influence electrolyte balance.
• Phosphate is an essential intracellular ion vital for numerous metabolic processes.

Purpose of the Study:

• To investigate the effect of different intravenous fluid regimens on plasma and urinary phosphate levels in major surgery patients.
• To compare phosphate levels between patients receiving 0.9% saline versus dextrose-saline solutions postoperatively.

Main Methods:

• Prospective study involving 13 patients undergoing major surgery.
• Measurement of plasma and urinary phosphate levels preoperatively and postoperatively.
• Administration of either 0.9% saline or 4% dextrose with 0.18% saline as maintenance intravenous fluid.

Main Results:

• Plasma phosphate levels decreased in all patients postoperatively, reaching a nadir on the second day.
• Patients receiving dextrose-saline solutions exhibited significantly lower plasma phosphate levels on postoperative days 2, 3, and 4 compared to the saline group.
• Phosphate levels in the dextrose-saline group fell below the normal range during the early postoperative period.

Conclusions:

• Dextrose-saline intravenous fluids can lead to significant hypophosphatemia in the early postoperative period.
• Phosphate levels should be monitored closely in surgical patients receiving dextrose-containing intravenous fluids.
• Consideration should be given to supplementing intravenous dextrose-saline solutions with phosphate to prevent or treat hypophosphatemia.