Selective review of key perioperative renal-electrolyte disturbances in chronic renal failure patients

The medical care of chronic renal failure patients is often complicated by the comorbid conditions of hypertension and coronary artery disease in the perioperative period. The limitations on solute and water excretion imposed by renal dysfunction increase the susceptibility of this population to bot h salt deficit and surfeit, as well as hyponatremia and hypernatremia perio peratively, Accurate assessment and successful treatment of these complicat ions in renal failure patients require understanding of the concert of elec trolyte-free water, proper utilization of diuretics, and calculated prescri ption of fluid therapy, The presence of hyperkalemia in the adapted renal f ailure patient generally indicates a severe reduction in glomerular filtrat ion, such that nonrenal hypokalemic treatments are imperative. IV calcium-b ased therapy and infusion of insulin with glucose represent the mainstays o f immediate therapy, and sodium bicarbonate therapy should be given only wh en severe acidemia is present, Perioperative aggravation of preexistent hyp ertension is common. Rebound hypertension attributable to injudicious adjus tment of the medical regimen should be diligently searched for first, befor e any new therapies are recommended. Relief of pain or anxiety may be all t hat is necessary. Briefly acting calcium channel blocker therapy should not be employed in these cases, and smooth IV control by a variety of agents i s preferable, the choice of the agent contingent on the clinical scenario.