Fluids and Electrolytes after weight loss surgery are an important part of recovery and lifestyle after undergoing a weight loss surgical procedure. Potassium is an important electrolyte found in higher concentrations within the fluid of the cells. It is important in muscle contraction, heart rhythm, nerve function and co-enzyme function.

Fluids and Electrolytes

The following webinar (link) discusses the balance of fluids and electrolytes with particular attention to post weight loss surgery concerns. Deficiencies can cause heart arrhythmias, muscle weakness and cramping, intestinal paralysis, and neurological deficits.

The Daily Recommended Amount for Potassium is  4,700mg

Here is a list of Lower-carb potassium sources: This is not meant to be in inclusive list.  There are many higher carb sources of potassium also.

• Beet Greens- 1/2C 655 mg
• Trout 3oz – 375 mg
• Salmon  719 mg per average filet
• Halibut or Yellowfin Tuna 3oz – 500mg
• Clams 3oz- 534 mg
• Avocados 1 whole- 974 mg
• Squash 1C- 325mg
• Broccoli 1 cup 475m
• Watermelon Radish 3 oz – 233mg
• Sweet Potatoes- one potato 694mg
• Yogurt 1C – 579mg
• Tomato paste 1/4C – 342 mg
• Whole milk 1C – 366 mg
• Chicken breast meat 1 cup chopped – 358 mg
• Cauliflower 1 cup raw– 303 mg
• Peanut butter 2 T – 208 mg
• Asparagus spears 6 – 194 m
• Daikon Radish – 3″ – 280 mg
• Nuts  100-300 mg per 30g / 1 oz serving, depending on the type
• Dark leafy greens  160 mg per cup of raw, 840 mg per cooked
• Kohlrabi 3oz- 98mg
• Mushrooms 1 C- 273 mg
• Spinach – 1 cup 167 mg Potassium
• Walnuts 2 oz-250 mg

Malnutrition is one of the most feared complication of the duodenal switch operation. It may present years after surgery. What is common is a mix of nutritional deficiencies which include fat soluble vitamins, and protein calorie malnutrition. These all point to possible excessive shortening of the common channel. In my practice we have seen patients that have had lengthening of their common channel to improve their metabolic picture. What is very obvious to us, is that we see disproportionately higher number of cases coming to us for revision from practices where the common and alimentary lengths are done as a “standard” numbers with no specific adjustments made for the patient, their anatomy and situation. I have said for years, that the length of the bowel that is measured to be become the common and the alimentary limb should be a percentage of the total length of small bowel, rather than a pre-determined measurement. Here is a visual description of how this works.

If a common channel and the alimentary limb is measured to be a percent of the total length then the chance of protein calorie malnutrition is minimized since this will take into account the bowels absorptive capacity which is being reduced. This decrease in the absorption is done as a fraction of the total length.

Raines et al. published  a study in 2014, that showed how small bowel length is related more closely to a patient’s height and not weight.  And yet, some surgeons totally based the length of the common channel and the alimentary limb arbitrarily based on the patient pre operative BMI and nothing else. Could this be the cause of why I see some patients coming to us for revision of their duodenal switch for malnutrition?

Most of you may have heard me emphasize the importance of adequate hydration after surgery. At the same time I would be the first one to admit that drinking plain water gets old very quickly. I also do not recommend carbonated drinks (diet or regular). Most commercial products such as Crystal light also contain artificial sweeteners which in my opinion are to be avoided. Please note that there is extensive information here on my website on this topic.

One of the most benign looking drinks may be the refreshers that are available at Starbucks. An example of it is Very Berry Hibiscus Starbucks Refreshers Beverage.  It contains 21 g of sugar and 100 calories in a 24 ounce serving size.  Note that  it also contains 70-85mg of  caffeine.

Having some of these drinks on occasion  will do no harm.  However I would not recommend these drinks to replace water  as means of hydration. High content of  Caffeine can result in oxalate crystal formation. This predisposes a post weight loss surgical patient to much higher chance of kidney stone formations.