OPTIMAL ELECTROLYTE MANAGEMENT AFTER CARDIAC SURGERY: A RETROSPECTIVE OBSERVATIONAL STUDY

Dr Jyoti Prasad Kalita; Prof. Manuj Kumar Saikia; Dr Intekhab Alam

Volume : VII, Issue : IV, April - 2018

OPTIMAL ELECTROLYTE MANAGEMENT AFTER CARDIAC SURGERY: A RETROSPECTIVE OBSERVATIONAL STUDY

Dr Jyoti Prasad Kalita, Prof. Manuj Kumar Saikia, Dr Intekhab Alam

Abstract :

Introduction

Electrolyte imbalance after cardiac surgery is an established finding which leads to higher incidence of ventricular and supraventricular arrhythmias. Patients undergoing cardiac surgical procedures under cardiopulmonary bypass is the most important cause of electrolyte depletion. Preventing electrolyte disorders is thus an important goal of therapy in such patients. Though the measurement of levels of potassium is done regularly, other electrolytes such as magnesium, and calcium are measured far less frequently. We therefore conducted the present study to assess electrolyte levels in such patients and the optimum level of these to avoid complications.

Methods

Levels of magnesium, potassium, calcium and sodium were measured in 160 consecutive patients undergoing various cardiac surgical procedures undergoing extracorporeal circulation were examined. The normal reference values for these electrolytes in our laboratory were as follows (all in mmol/l): magnesium 0.8–1.1, potassium 3.8–4.8, calcium 2.20–2.60 and sodium 135–145. The patients were divided in two groups keeping a cut of as follows (all in mmol/l): magnesium 1.0, potassium 4.0, calcium 2.5 and sodium 135 , Group 1 has lower than the cut of mark and group 2 had higher than the cut of mark. Intravenous potassium supplementation and magnesium supplementation was received at the time of surgery. Serum magnesium, potassium, calcium and sodium concentrations were determined onICUadmissionand6,24 and 48 hrs later.

Results

There was signiﬁcant differences were found either in the primary end point (hours of intubation) or in the secondary end points (length of inotropic support, new atrial ﬁillation, ventricular tachycardia or ventricular ﬁillation, length of intensive care unit stay, ICU or hospital mortality).

Conclusion

Patients undergoing cardiac surgery with extracorporeal circulation are at high risk for electrolyte depletion, despite intraoperative supplementation. The probable mechanism is a combination of increased urinary excretion and intracellular shift induced by a combination of extracorporeal circulation and decreased body temperature during surgery (hypothermia induced diuresis). Our findings may partly explain the high risk of tachyarrhythmia in patients who have undergone cardiac surgery. Prophylactic supplementation of potassium, magnesium and calcium should be seriously considered in all patients undergoing cardiac surgical procedures, should be kept at higher normal range.Levels of these electrolytes should be monitored frequently in such patients.