A 60 years old diabetic woman has been scheduled for total knee replacement electively. She has diabetic nephropathy and her blood urea nitrogen is 32mg/dL. Her serum creatinine is 2.3 mg/dL. Her haemoglobin is 9 g/dL.

 (1)   All the following are important strategies to reduce her surgical risk except:

 (a)    Maintaining a serum potassium below 5.5 mEq/L

(b)   Posting for a hemodialysis on the day prior to surgery.

(c)    Human recombinant colony stimulating factors to correct leukopenia

(d)   Human recombinant erythropoietin to correct anaemia.

 Answer: The answer is (c). Maintaining a potassium level below 5.5 mEq/L is recommended to prevent arrhythmias in the postoperative period. Uraemia can cause several problems including prolonged bleeding time due to platelet dysfunction. Therefore it is advisable to have a hemodialysis done the day prior to the surgery to prevent this complication. Anemia needs to be corrected by administering human recombinant erythropoietin.