How do you evaluate the perioperative risk of common acute metabolic derangements (e.g., hyponatremia, acid-base disturbances, electrolyte deficiencies, etc.)?

I approach perioperative metabolic abnormalities as markers of a patient’s current physiologic stability and reserve, rather than as isolated laboratory values that must all be normalized. I first confirm an unexpected result and assess its acuity, trajectory, likely cause, symptoms, volume status, ...