J.Jpn. Surg. Soc.. 55(12): 1237-1262, 1955

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Original article

THE ANALYSIS OF DISTURBANCES IN THE METABOLISM OF WATER AND ELECTROLYTES BEFORE AND AFTER SURGERY

The author attempted to clarify the nature and mode of various kinds of disturbances in the metabolism of water and electrolytes, taking about 150 surgical patients and 50 dogs. It the majority of cases, the volume of total body water and extracellular fluid, and the concentration of serum electrolytes and total solutes were measured. The influence of some hormonal factors upon these changes were also taken into cosideration.
The findings obtained are as follows :
1) Some physiological factors in relation to body fluid exchange, namely, renal haemodynamics, osmotic diuresis, water diuresis, diurnal rhythm, and posture changes were examined. After operation renal haemodynamics drops for a few hours. During this postoperative period, osmotic diuresis and water diuresis are lacking.
During the midnight or in a standing position, more water is retained than during the daytime or in a lying position.
The phenomena of water retention are found to be dependent upon the increased secretion of ADH from the neurohypophysis.
2) Premedication of opium-scopolamine diminishes conspicuously the plasma volume, especially in the case of hypoproteinemia. Intravenous anesthesia increases the plasma volume and reduces the extracellular space. On the contrary, inhalation anesthesia diminishes the plasma volume and increases the extracellular space.
3) For a few days after the minor operation, changes of total body water, plasma volume, water and electrolyte balance are minimal, when our mixed nutritional solution is administered, in this sence the mixed nutrient qualified as an ideal replacement substance.
4) In general, the retention of water and sodium is remarkable for a period of 24-36 hours after operation; and the degree of retention is in the whole parallel to the level of the serum antidiuretic substance. The change of serum concentration of total solutes is not uniform, but EF tends to increase.
5) In the stadium of postoperative recovery diuresis, the total solute concentration and volume of urine reach higher level than in preoperative stadium. From the clinical point of view, this recovery diuresis resembles the features of so-called "physiologic" diabetes insipidus.
6) Some illustrative cases of disturbances of water and electrolyte metabolism are exemplified, such as hypotonic dehydraton, edema of the lung, sodium depletion, acidosis after pancreatectomiy, hypopotassemia etc., and the natures and causes of their appearance, clinical cources, signs and symptoms, treatment, and some hormonal factors are ascertained.
7) In the condition of postoperative adrenal insufficiency, not rarely the level of serum potassium increases quickly after the intravenous injection of hypertonic glucose solution (Fukuda's phenomenon).
The genesis of this phenomenon is seemingly related fo postoperative anuria or oliguria, the decline of the utilization of glucose, and the liberation of acetylcholine.
Adrenaline is proved to lower the serum potassium level and is able to suppress the occurrence of this postinjecton hyperpotassemia.
(author's abstract)

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