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  • Title: Audit of changes in serum urea and electrolytes following peri-operative intravenous fluid therapy.
    Author: Ip-Yam PC, Wood PJ, Seng C.
    Journal: Singapore Med J; 1998 Jan; 39(1):20-4. PubMed ID: 9557099.
    Abstract:
    One thousand and eleven patients discharged from the postoperative recovery ward with intravenous infusions were reviewed in order to audit the extent of assessment of serum urea and electrolytes (U&Es) and the change in serum U&Es over the perioperative period. 69.7% had preoperative U&Es estimation, 42.5% had both a pre- and postoperative estimation and in 5%, only a postoperative estimate was undertaken. 12.2% of patients whose U&Es were measured had an abnormal preoperative serum potassium compared to 17.2% postoperatively (NS). Compared to a preoperative incidence of 13%, more patients (27.3%) had an abnormal postoperative serum sodium (p < 0.0001). There was a tendency towards postoperative hyponatraemia: 10.0% in the preoperative period compared to a postoperative 25.3% (p < 0.0001). More tests were performed in the elderly (83.9% in age > 65 years versus 69% in age 17-64-p < 0.0001) who were more likely to have electrolyte disturbances preoperative hypokalaemia (p < 0.05), postoperative hyperkalaemia (p < 0.05), postoperative hyponatraemia (p < 0.03) and raised serum urea, both pre- and postoperatively (p < 0.0001 and p < 0.0005 respectively). Patients undergoing intraabdominal procedures did not have significantly different peri-operative electrolyte abnormalities. Fewer tests were performed in emergency patients, who were hypokalaemic in the postoperative period compared to elective patients (p < 0.01). There was a higher incidence of preoperative hyponatraemia and raised serum urea in the emergency group (p < 0.001 and p < 0.0002 respectively). Neurosurgical emergencies often had a degree of preoperative hypokalaemia which persisted after surgery (p < 0.0001). Results indicate an increased risk of serum electrolyte abnormalities following peri-operative intravenous fluid therapy. However in the majority of patients, the magnitude of the change is not significant clinically.
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