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Background <p>Electrolyte imbalances are common yet under-recognized complications in elderly patients undergoing major orthopedic surgeries. Sodium (Na⁺) and potassium (K⁺) disturbances, if unaddressed, can lead to delayed recovery and increased perioperative morbidity. This study aimed to evaluate the pattern and timeline of postoperative sodium and potassium changes in elderly orthopedic patients to guide appropriate monitoring and management.</p> Methods <p>This prospective observational study was conducted at the Department of Orthopaedics and Trauma Centre, J.A. Group of Hospitals, Gwalior, over 18&#xa0;months. A total of 75 geriatric patients (aged ≥ 60&#xa0;years) undergoing major lower-limb orthopedic procedures—bipolar hemiarthroplasty, DHS, PFN, THR, or TKR—were enrolled. Patients with pre-existing renal, hepatic, or cardiac disorders or active infection were excluded. Serum sodium and potassium levels were measured preoperatively and at five postoperative time points: within 6&#xa0;h (Day 0) and on Days 2, 3, 14, and 30. Data were analyzed using SPSS v20 with Wilcoxon signed-rank tests (<i>p</i> &lt; 0.05).</p> Results <p>Mean serum sodium decreased from 138.5 ± 1.6&#xa0;mEq/L preoperatively to 135.1 ± 1.7&#xa0;mEq/L on Day 2, while mean potassium declined from 4.0 ± 0.4&#xa0;mEq/L to 3.5 ± 0.2&#xa0;mEq/L during the same period (<i>p</i> &lt; 0.05). THR and TKR patients showed the greatest reductions. Sodium levels generally normalized by postoperative Day 14 in most groups, whereas potassium levels stabilized earlier. No postoperative mortality was observed.</p> Conclusion <p>Elderly patients undergoing major orthopedic surgeries frequently develop transient postoperative hyponatremia and hypokalemia, most notably within the first 72&#xa0;h. Focused biochemical monitoring during this early period and continued follow-up until postoperative Day 14 may help prevent complications and support recovery in this vulnerable population.</p>

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Early Postoperative Hyponatremia and Hypokalemia in Elderly Orthopedic Patients: Implications for Clinical Monitoring

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Arpit Agrawal,
  • Devesh Bandil,
  • Prashant Agrawal,
  • Shatrughan Singh Tomar,
  • Arunaditya Singh Thakur,
  • Ram Krishan Singh Dhakad

摘要

Background

Electrolyte imbalances are common yet under-recognized complications in elderly patients undergoing major orthopedic surgeries. Sodium (Na⁺) and potassium (K⁺) disturbances, if unaddressed, can lead to delayed recovery and increased perioperative morbidity. This study aimed to evaluate the pattern and timeline of postoperative sodium and potassium changes in elderly orthopedic patients to guide appropriate monitoring and management.

Methods

This prospective observational study was conducted at the Department of Orthopaedics and Trauma Centre, J.A. Group of Hospitals, Gwalior, over 18 months. A total of 75 geriatric patients (aged ≥ 60 years) undergoing major lower-limb orthopedic procedures—bipolar hemiarthroplasty, DHS, PFN, THR, or TKR—were enrolled. Patients with pre-existing renal, hepatic, or cardiac disorders or active infection were excluded. Serum sodium and potassium levels were measured preoperatively and at five postoperative time points: within 6 h (Day 0) and on Days 2, 3, 14, and 30. Data were analyzed using SPSS v20 with Wilcoxon signed-rank tests (p < 0.05).

Results

Mean serum sodium decreased from 138.5 ± 1.6 mEq/L preoperatively to 135.1 ± 1.7 mEq/L on Day 2, while mean potassium declined from 4.0 ± 0.4 mEq/L to 3.5 ± 0.2 mEq/L during the same period (p < 0.05). THR and TKR patients showed the greatest reductions. Sodium levels generally normalized by postoperative Day 14 in most groups, whereas potassium levels stabilized earlier. No postoperative mortality was observed.

Conclusion

Elderly patients undergoing major orthopedic surgeries frequently develop transient postoperative hyponatremia and hypokalemia, most notably within the first 72 h. Focused biochemical monitoring during this early period and continued follow-up until postoperative Day 14 may help prevent complications and support recovery in this vulnerable population.