How do I install the Ppgl Preoperative Salt Saline Protocol skill?

Run npx skillmds@latest add dromlakhani/ppgl-preoperative-salt-saline-protocol in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Ppgl Preoperative Salt Saline Protocol safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: docs only. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Ppgl Preoperative Salt Saline Protocol?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ppgl Preoperative Salt Saline Protocol free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Ppgl Preoperative Salt Saline Protocol?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ppgl Preoperative Salt Saline Protocol by dromlakhani

Name: Ppgl Preoperative Salt Saline Protocol
Rating: 4.5 (4 reviews)
Author: dromlakhani

Ppgl Preoperative Salt Saline Protocol

Implements preoperative salt loading and saline infusion to prevent orthostatic hypotension and hemodynamic instability during PPGL surgery. Initiates normal salt diet (9 g/day) on day 3 of alpha-blockers and administers 1-2 L saline infusion from evening before surgery until surgery for patients scheduled for PPGL surgical resection, completing preoperative alpha-blocker titration, or preventing intraoperative hypotension in PPGL surgery.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Preoperative Salt and Saline Infusion Protocol for PPGL

STEP 1 — Gather Information

Confirm PPGL diagnosis, surgical scheduling, current alpha-blocker regimen and titration status, baseline blood pressure, orthostatic vitals, and signs of volume depletion; review cardiac and renal function for fluid safety.

STEP 2 — Rule In / Rule Out

Rule in if patient has biochemically or imaging-confirmed PPGL, is scheduled for surgical resection, and is on or completing preoperative alpha-blocker titration; rule out if any criterion is missing.

STEP 3 — Classify or Stratify

Assess for orthostatic hypotension (systolic drop ≥20 mmHg or diastolic ≥10 mmHg on standing) and blood pressure control; if present, prioritize salt loading; if absent, proceed with standard salt diet.

STEP 4 — Decide

Initiate normal salt diet (9 g/day) starting on day 3 of alpha-blocker therapy; administer 1–2 L isotonic saline infusion from the evening before surgery until surgery to expand plasma volume.

Clinical Guardrails / Mimics / Pitfalls

Do not start salt loading before day 3 of alpha-blockers (may exacerbate hypertension); avoid excessive salt in patients with decompensated heart failure or severe renal impairment; monitor for pulmonary edema during saline infusion; do not replace individualized blood pressure goals with protocol alone.

Concrete Clinical Example

A 52-year-old with adrenal PPGL on day 2 of phenoxybenzamine 10 mg BID, BP 138/86 mmHg, no orthostatic symptoms, scheduled for laparoscopic adrenalectomy tomorrow; start 9 g/day salt diet today (day 3) and begin 1.5 L saline infusion tonight.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI: 10.1507/endocrj.EJ25-0165

---name: ppgl-preoperative-salt-saline-protocoldescription: Implements preoperative salt loading and saline infusion to prevent orthostatic hypotension and hemodynamic instability during PPGL surgery. Initiates normal salt diet (9 g/day) on day 3 of alpha-blockers and administers 1-2 L saline infusion from evening before surgery until surgery for patients scheduled for PPGL surgical resection, completing preoperative alpha-blocker titration, or preventing intraoperative hypotension in PPGL surgery.---# Preoperative Salt and Saline Infusion Protocol for PPGL## STEP 1 — Gather InformationConfirm PPGL diagnosis, surgical scheduling, current alpha-blocker regimen and titration status, baseline blood pressure, orthostatic vitals, and signs of volume depletion; review cardiac and renal function for fluid safety.## STEP 2 — Rule In / Rule OutRule in if patient has biochemically or imaging-confirmed PPGL, is scheduled for surgical resection, and is on or completing preoperative alpha-blocker titration; rule out if any criterion is missing.## STEP 3 — Classify or StratifyAssess for orthostatic hypotension (systolic drop ≥20 mmHg or diastolic ≥10 mmHg on standing) and blood pressure control; if present, prioritize salt loading; if absent, proceed with standard salt diet.## STEP 4 — DecideInitiate normal salt diet (9 g/day) starting on day 3 of alpha-blocker therapy; administer 1–2 L isotonic saline infusion from the evening before surgery until surgery to expand plasma volume.## Clinical Guardrails / Mimics / PitfallsDo not start salt loading before day 3 of alpha-blockers (may exacerbate hypertension); avoid excessive salt in patients with decompensated heart failure or severe renal impairment; monitor for pulmonary edema during saline infusion; do not replace individualized blood pressure goals with protocol alone.## Concrete Clinical ExampleA 52-year-old with adrenal PPGL on day 2 of phenoxybenzamine 10 mg BID, BP 138/86 mmHg, no orthostatic symptoms, scheduled for laparoscopic adrenalectomy tomorrow; start 9 g/day salt diet today (day 3) and begin 1.5 L saline infusion tonight.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI: 10.1507/endocrj.EJ25-0165

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