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Liver transplantation: Electrolyte disturbances

According to Miller, “Abnormalities in sodium electrolyte levels are frequently observed and are often related to volume status and sodium retention; these abnormalities can result in eitherhyponatremia or hypernatremia“. Other common abnormalities in ESLD includehyperkalemia,hypokalemia, andhypomagnesemia.

During the liver transplant itself,hypocalecmiais extremely common during dissection and the anhepatic phases, but also due to chelation of calcium via citrate (most in FFP and platelets, seeFFP: Citrate toxicity Dx/Rx)

Electrolyte Abnormalities in ESLD

  • Sodium: hyponatremia or hypernatremia (related to volume status)
  • Potassium: hyperkalemia or hypokalemia (due to diuretic use)
  • Magnesium: hypomagnesemia
  • Calcium: hypocalcemia intraoperatively


  1. W Ray Kim, Scott W Biggins, Walter K Kremers, Russell H Wiesner, Patrick S Kamath, Joanne T Benson, Erick Edwards, Terry M Therneau Hyponatremia and mortality among patients on the liver-transplant waiting list. N. Engl. J. Med.: 2008, 359(10);1018-26 Filed Under: Clinical - Hepatic, Clinical - Renal/Urine/Electrolytes, L Link

Other References

  1. Keys to the Cart: December 5, 2016; A 5-minute video review of ABA Keywords Link