Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature

Abstract

Background. Hysteroscopic surgery is a minimally invasive procedure used to diagnose and treat intrauterine pathologies. It requires distension of the uterine cavity for the adequate visualization of the operative field. Glycine (1.5%) is one of the most commonly used solutions because it is nonconductive and also has good optical properties. However, acute hyponatremia is a critical complication that can develop after the absorption of a sufficient amount of the irrigation medium. Case Presentation. We report a case of a 43-year-old female patient who developed acute symptomatic hyponatremia (104 mEq/L) and pulmonary edema secondary to hysteroscopic resection of leiomyoma and hastily approached with rapid sodium correction measures. Conclusion. Multiple strategies can be taken to reduce the risk of fluid absorption and subsequent hyponatremia. Moreover, attention should be paid to the treatment approach for patients with acute hyponatremia following hysteroscopic procedures; rapid correction of acute hyponatremia for such patients might be safe, although there is no consensus in the literature, and further trials are needed.

Rapid correction of severe hyponatremia and control of subsequent overcorrection in operative hysteroscopy intravascular absorption syndrome: A case report

“…[6] In the majority of OHIAS and TURP syndrome cases, a sharp decrease in serum Na + level by electrolyte-free lavage did occur but was successfully reversed. [7] In patients with severe postoperative hyponatremia (80-110 mM), use of 3% NaCl solution could increase serum Na + level by 20-30 mM within 12-24 hours, and most of them were successfully treated without sequelae. This is supported by the fact that the rapid onset of hyponatremia is so short-lived that cerebral adaptation is insufficient; therefore, the risk of ODS is low.…”

Clinical Issues — March 2023

“…Fluid extravasation occurs when fluid moves into the tissues and can lead to edema, 1,2 airway compromise, 1,2 abdominal distension, 3 and compartment syndromes near the operative site 3 . Fluid intravasation occurs when fluid is absorbed into the vasculature through vessels that are disrupted during resection of tissue and can lead to hyponatremia; 2,4 hypervolemia; 5 and cardiovascular, pulmonary, or neurological complications 1,4,5 . Several studies have reported instances of airway compromise with shoulder arthroscopy and intra‐abdominal compartment syndrome after hip arthroscopy that were associated with extravasated fluid that had moved into the tissues 1,3,6,7 .…”

“…Treatment for fluid overload can include respiratory support (eg, supplemental oxygen, endotracheal intubation with ventilatory support); 2,4 administration of diuretics to eliminate excess fluid, 2 hypertonic IV sodium chloride to treat the electrolyte imbalance, 2,4 and bicarbonate to correct acidosis; 2 and continued monitoring until symptoms and fluid and electrolyte imbalances resolve 2,4 . Healthy adults can accommodate some fluid absorption, but older adult patients or patients with comorbidities (eg, cardiovascular or renal dysfunction) are less tolerant and at an increased risk of developing hyponatremia and fluid overload 8,12 …”

Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina

“…La glicina al 1,5% es una solución hipotónica con osmolaridad de 200 mOsmol/l y un pH entre 4,5 y 6,5, se utiliza para irrigación en histeroscopia por permitir buena visualización por fibra óptica y facilitar la electrocirugía monopolar al no ser electroconductivo 3 . El compuesto activo de la glicina es el 2-ácido aminoacético, que al ser absorbido es metabolizado en amonio por el hígado y excretado por vía renal 4 .…”

“…La paciente con anestesia neuroaxial al estar despierta podrá referir síntomas del SAIH como dificultad respiratoria, cefalea y náuseas. La glicina puede dar alteraciones visuales por inhibición nerviosa en las células de la retina 4 ; en cambio con anestesia general el diagnóstico es más difícil y tardío, la desaturación de oxígeno, la disminución del nivel de dióxido de carbono al final de la espiración (EtCO 2 ) y el aumento de presiones de vías aéreas son sugerentes de edema pulmonar mientras la taquicardia e hipertensión arterial deben hacernos sospechar de hipervolemia 6 .…”