Fluids and Electrolytes in the Surgical Patient reviewed by GAB

Guest Writer: GAB
founder of MedSchoolForums, a great friend of mine and a man I would never trust with money or a girlfriend but, he writes a great review!

Review of the book

Fluids and Electrolytes in the Surgical Patient (Paperback) by Carlos Pestana

Care of the in-patient, in particular one who for whom oral food and fluids have been withheld, is rather like juggling chainsaws in requiring assiduous attention to detail. The tidal influx and efflux of water and the complicated, co-ordinated dance of serum electrolytes must be catalogued, synthesised and catered for. This vital care, which one is expected to master on the first day of internship, is a very practical skill-set whose foundations are rooted deeply in the abstract knowledge-base of the pre-clinical physiology classroom.

In “Fluids and Electrolytes in the Surgical Patient”, Dr. Pestana contends that these pre-clinical lectures, for all their excellence and value, do not provide a guide-book to the treatment of patients “whose electrolytes are out of whack. Clinicians do that. You rub elbows with clinicians in the clinical years of your medical education but often that’s all you do. You are in close physical proximity to someone who may be too busy to explain why the order reads D5W rather than D5½NS.”

The author later points out that one of the consequences of this is the house-officer who has not been taught to think in terms of patterns of volume and tonicity change affecting his patients. “He is the guy who stops you in the hall waving a lab slip with a serum sodium report in it and asks you what to do about it but tells you nothing about the patient to whom the report belongs”. Indeed, it is the experience of many medical students and junior doctors that there is a gap in their ability to translate the weight of basic science they are taught into ‘fit for purpose’ clinical know-how; some confess that the extent of their practice was to prescribe 3 litres of clear maintenance fluids – one of normal saline and two of 5% dextrose, each with 20mmol KCl and run over 8 hours, without a clear integrative understanding of why they were doing this.

There is no cerebral self-aggrandisement or obfuscation in this little book, which takes on the comfortable character of a series of bedside tutorials on fluid maintenance and replacement, volume changes and tonicity, specific electrolytes, acid/base balance and nutrition. As the work of a single experienced author, all topics are tackled with a consistent voice. I found myself happily taken-in by the single author’s avuncular yet masterful explanation of concepts and their clinical application and I finished each chapter with a satisfying sense of having deeply learned something of immense practical value.

Extensive and useful reference tables are provided, but the real strength of this book lies in the author’s insistence that no concept or association is left unexplained. Each chapter ends with a short list of the salient points, values and formulae necessary for memorisation and understanding, and all of these are tied together in a beautiful ‘troubleshooting’ addendum to the book.

I predict my pristine copy of “Fluids and Electrolytes in the Surgical Patient” will become dog-eared with constant re-reading, and I unreservedly commend this book, both for the replacement of specific deficits and for timely maintenance.

Reviewer:

Gary Bass MSc, Final Year Medical Student, Royal College of Surgeons in Ireland Dublin and Founder of www.medschoolforums.com

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