Rapid correction of severe hyponatremia after hysteroscopic surgery – a case report

• Published in: BMC anesthesiology 2015-06, Vol.15 (1), p.85-85, Article 85
• Main Authors: Hepp, Philip, Jüttner, Tobias, Beyer, Ines, Fehm, Tanja, Janni, Wolfgang, Monaca, Enrico
• Format: Article
• Language: English
• Subjects: Acute Disease; Care and treatment; Case Report; Case studies; Diagnosis; Female; Health aspects; Humans; Hyponatremia; Hyponatremia - etiology; Hyponatremia - therapy; Hysteroscopy; Hysteroscopy - adverse effects; Hysteroscopy - methods; Middle Aged; Pulmonary Edema - etiology; Pulmonary Edema - therapy; Risk factors; Severity of Illness Index; Treatment Outcome
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-015-0070-4

One of the most feared complications during hysteroscopic surgery is haemodilution by absorption of distension media. One facet of haemodilution, i.e. hyponatremia, can lead to respiratory distress, pulmonary oedema, as well as cardiovascular collapse. Here we report the swift recovery of a 45 year, female, Caucasian patient with acute hyponatremia (74 mEq/L) and pulmonary oedema by the employment of rapid correctional strategies. The absorption of irrigation fluids, as presented in this case, is an inevitable side effect of hysteroscopic surgery. Utmost caution should, therefore, be mandatory to reduce and actively monitor fluid intake. If these measures fail, as in the case presented here, it is essential to rapidly eliminate any free water and to normalize the sodium levels. Anecdotal reports of pontine myelinolysis are not in line with literature concerning acute hyponatremia and should, therefore, not obstruct determined action against it.