Postoperative Water and Sodium Retention

Quesne, L. P. Le; Lewis, Al

doi:10.1016/s0140-6736(53)90778-8

Cited by 100 publications

(14 citation statements)

References 18 publications

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“…Le Quesne & Lewis (1953) have attributed the postoperative response to the fusion of three separate events: primary water retention; early Na retention; late Na retention. They found that primary water retention is independent of Na retention and is rarely maintained after the first 24 h. The result of primary water retention is oliguria with high specific gravity and is mediated by the release of antidiuretic hormone.…”

Section: Clinical Relevancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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Fluid and electrolyte balance is often poorly understood and inappropriate prescribing can cause increased post-operative morbidity and mortality. The efficiency of the physiological response to a salt or water deficit, developed through evolution, contrasts with the relatively inefficient mechanism for dealing with salt excess. Saline has a Na + :Cl -of 1 :1 and can produce hyperchloraemic acidosis, renal vasoconstriction and reduced glomerular filtration rate. In contrast, the more physiological Hartmann's solution with a Na + :Cl -of 1 . 18 :1 does not cause hyperchloraemia and Na excretion following infusion is more rapid. Salt and water overload causes not only peripheral and pulmonary oedema, but may also produce splanchnic oedema, resulting in ileus or acute intestinal failure. This overload may sometimes be an inevitable consequence of resuscitation, yet it may take 3 weeks to excrete this excess. It is important to avoid unnecessary additional overload by not prescribing excessive maintenance fluids after the need for resuscitation has passed. Most patients require 2-2 . 5 litres water and 60-100 mmol Na/d for maintenance in order to prevent a positive fluid balance. This requirement must not be confused with those for resuscitation of the hypovolaemic patient in whom the main aim of fluid therapy is repletion of the intravascular volume. Fluid and electrolyte balance is a vital component of the metabolic care of surgical and critically-ill patients, with important consequences for gastrointestinal function and hence nutrition. It is also of importance when prescribing artificial nutrition and should be given the same careful consideration as other nutritional and pharmacological needs.

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Section: Clinical Relevancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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“…Aldosterone is only one of the factors involved in Na þ handling and some studies have been made on atrial natriuretic hormone. 17 Renal retention of Na þ is well documented in patients following trauma or major surgery 18,19 but it usually only lasts for 48 hours. In our patients, Na þ retention was most marked in those with complete cervical transections and, by contrast, lasted for up to 10 days.…”

Section: Discussionmentioning

confidence: 99%

Reduced sodium output following acute spinal injury

Silver

Doggart

2004

Spinal Cord

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Study design: Assessment of sodium output in spinal injury patients. Objectives: The purpose was to examine the effects of sodium loading acutely by an infusion, long term by sodium supplements, to acutely injured spinal patients on a fixed sodium intake. This was compared with another group of acutely injured patients who were on a hospital diet of between 50 and 150 mmol of sodium daily. Setting: The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL, UK. Methods: A total of 53 studies were carried out on 52 patients between 1962 and 1964. In all, 49 patients were studied during the first 10 days after injury as follows: a control group of 39 patients received no supplementary sodium, two received NaCl infusion, two NaCl tablets orally, and six received NaCl infusion followed by NaCl tablets orally. Four patients were studied for more than 15 days after injury (one of these had been studied in the acute stage); they received NaCl infusion and one (42d) received in addition NaCl tablets for four subsequent days. Results: In all patients urinary sodium excretion was minimal on day 2 and increased thereafter. On days 2-6, it was significantly lower in patients with a complete transection of the cervical cord than in patients with lower lesions. In the early studies, nine patients excreted less than 40% of the administered load within 24 h. In four of these patients excretion was 10% or less. In the later studies, three of the four patients excreted at least 80% of the infused Na þ on the same day. Conclusion: Sodium retention in the patient with cord injury is a response to trauma. The different responses seen in patients with different levels of cord transection are not due to direct changes in the innervation of the kidney but to compensation for sympathetic insufficiency, blood pressure being maintained by the secretion of aldosterone, vasopressin and other hormones. The decreased urinary output seen acutely after cord transection is not due to renal failure and the patient's condition can be made dangerously worse by attempts to create a diuresis.

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“…The volume and concentration of the urine during and immediately after surgical injury have been widely ascribed to the predominant influence of ADH (2,3,13). Although, in our patients, urine volume is low and within the range associated with maximal antidiuresis, U,,, (X = 434mosmol/kg) is only moderately in excess of plasma.…”

Section: Discussionmentioning

confidence: 99%

The hourly pattern of urine solute and electrolyte excretion following standard surgical trauma

Kapadia

Chan

Johnson

et al. 1983

Journal of British Surgery

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Although urine volume (and, less frequently, concentration) is often measured in the perioperative period, little attempt has been made to separate temporal phases of the intra- and postoperative response to surgery. In 7 patients undergoing standard severe single trauma and managed by a conventional regimen which included intraoperative Hartmann's solution, we have investigated the hourly pattern of urine solute and electrolyte excretion over the first 48 h. Contrary to expectation, in the first 5 h Na+ excretion increases in association with overall solute excretion, and thereafter progressively diminishes. K+ excretion increases 4 h postoperatively and remains elevated for 24 h, after which it returns to normal, even though Na+ excretion remains low. Free water excretion is negative for the first 24 h, though urine osmolality does not suggest a maximal antidiuretic response by the kidney--the highest concentration achieved being just below 800 mosmol/kg. In order to distinguish between the physiological adaptive changes due to starvation and those due to injury, the hourly pattern of urine solute and electrolyte excretion was further investigated in 12 healthy volunteers mimicking postoperative conditions. Apart from the early postoperative period, the hourly pattern of Na+, K+ and osmolar excretion shows no discernible difference from the operated group. These results show that, particularly in relation to Na+, the changes seen in the post-injury patient, even after major uncomplicated surgery, are largely adaptive, and this is especially striking at 24 h after surgery.

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Postoperative Water and Sodium Retention

Cited by 100 publications

References 18 publications

Fluid, electrolytes and nutrition: physiological and clinical aspects

Fluid, electrolytes and nutrition: physiological and clinical aspects

Reduced sodium output following acute spinal injury

The hourly pattern of urine solute and electrolyte excretion following standard surgical trauma

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