THE ESTIMATION AND CONTROL OF POST-OPERATIVE DEHYDRATION, WITH THE AID OF HEMOGLOBIN AND PLASMA PROTEIN DETERMINATIONS 1

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Abstract
After major surgical procedures, the post-operative fall in Hb conc. follows a regular curvilinear course over a period of from 2 to 4 days when complications are absent, but the extent of the fall is often much greater than would be expected on the basis of the amt. of blood lost at operation. The most likely explanation for this is that there is a post-operative inhibition of Hb formation and hematopoiesis, although changes in vascular vol. and even hemolytic processes may contribute to the result. Since the post-operative fall in Hb conc. follows a regular curvilinear course, a simple rule for regulating the water requirements of a patient post-operatively is to estimate the probable daily Hb level, being guided by the general shape of the curve, and then to give the smallest amt. of intravenous water which will keep the Hb from rising above the estimated level for the day. This procedure gives results which are more simply obtained, and which we believe to be more dependable, than those which may be expected from the intake and output records kept under the avg. hospital conditions. An approx. linear relation exists between the effectiveness of an infusion and the extent of the dehydration present. This relation enables one to estimate the extent of the dehydration present in any given case from the effect produced by a measured volume of infusion. After partial gastrectomy and partial colon resection, the plasma protein conc. falls to a much greater extent than would be expected from the amt. of blood lost at operation. It is suggested that this post-operative fall in plasma protein conc. is largely due to a disturbance of the physiological mechanism which maintains the steady state, and that this disturbance bears a relation to the inhibition of hematopoiesis which occurs at about the same time (see 1 above).

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