Variability in post-operative fluid and electrolyte prescription

Area of Science:

• Anesthesiology
• Surgical Care
• Intravenous Fluid Therapy

Background:

• Post-operative fluid and electrolyte management is critical for patient recovery.
• Current practices in intravenous fluid prescription exhibit considerable variability.
• Understanding the physiological changes post-surgery is key to optimizing fluid therapy.

Purpose of the Study:

• To analyze current intravenous fluid and electrolyte prescribing patterns in post-operative surgical patients.
• To identify variability in fluid and electrolyte administration.
• To correlate prescribed electrolytes with patient serum levels and surgical type.

Main Methods:

• A four-week retrospective survey of intravenous fluid and electrolyte prescriptions.
• Analysis of fluid volumes, sodium, and potassium prescribed.
• Comparison of prescriptions between emergency and routine surgery patients.
• Assessment of correlation between prescribed electrolytes and serum electrolyte values.

Main Results:

• Wide variability observed in prescribed intravenous fluid volumes (median 3000 ml) and electrolytes (sodium median 242 mmol/day, potassium median 0 mmol/day).
• Emergency surgery patients received significantly more sodium than routine surgery patients (p = 0.0403).
• 0.9% saline was the most frequently prescribed fluid; poor correlation between prescribed and serum electrolyte levels was noted.

Conclusions:

• Intravenous fluid prescriptions require adjustment for the post-operative stress response, which typically lowers sodium needs and increases potassium loss.
• A balanced maintenance fluid, such as 4% dextrose/0.18% saline with potassium chloride, is recommended when serum electrolytes are unknown.
• Replacement of other fluid losses should utilize equivalent fluid types.