Whilst there are no specific surgical complications of salt-wasting alkaloses (SWA), these patients may require surgical procedures like anyone else. Hypokalaemia and hypomagnesaemia are common in patients with SWA. There are perioperative risks associated with hypokalaemia, which may be potentiated by low magnesium levels. These include arrhythmia, weakness, tetany, ileus, metabolic alkalosis and confusion. ECG changes seen in hypokalaemia included increased P-wave amplitude, prolonged PR interval, apparent QT interval prolongation, reduction in T-wave amplitude, T-wave inversion, ST segment depression and U-waves. However the current perioperative approach in patients with SWA is inconsistent, and patients may equally be denied surgery on the basis of chronic and stable metabolic derangement. The purpose of this guideline is to reduce this variation and therefore improve practice. The US National Guideline Clearinghouse does not contain existing guidelines on this subject.