Fatal hyponatremia in a 7-year-old girl with cloacal exstrophy after cystoscopy for a bladder stone

Walker, Macie B.; Fuhr, Peter G.; Koyle, Martin A.

doi:10.1016/j.jpurol.2007.12.004

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Despite being a disorder so common, there are few published cases on neurological manifestations in hyponatraemia in children in last 10 years and virtually no series (7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

et al. 2013

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“…Dans la littérature ce chiffre d'hyponatrémie a été corrélé avec des cas de fatalité. 4,9,10,[15][16][17] Une revue des cas cliniques publiés montre que le retard dans l'administration du sérum salé hypertonique, 6,9,17 son omission dans la thérapie de l'hyponatrémie aigue, 4,16,18 ainsi que l'hypoxie associée, 19,20 sont les facteurs aggravant l'encéphalopathie hyponatrémique conduisant au décès.…”

Section: Discussionunclassified

Severe hyponatremia associated with transcervical resection of a uterine myoma

Ziade¹,

Achkouty²,

Mrad³

2009

Can J Anesth/J Can Anesth

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Purpose Sever hyponatremia is associated with a high mortality rate. It can occur during procedures requiring irrigation with a glycine solution. Clinical features A 31-year old female patient underwent transcervical resection of a uterine myoma under general anesthesia. 35 minutes into surgery, a 41 min -1 bradycardia with hypertension (150/86 mmHg) was observed, followed by a 50 cmH 2 O increase in airway pressure and an expired CO 2 of 49 mmHg, a sodium of 100 mmoles L -1 and a negative irrigation fluid water balance of 3000 mL. After administering 600 mL of 3% hypertonic saline, 60 mg of furosemide, performing a transvaginal puncture to release the extravased fluid in the peritoneal cavity, and artificial ventilation for 6 h, positive outcome was finally achieved. Conclusions The resorption syndrome during transcervical resection of a uterine myoma is linked to the passage into the blood of the irrigation fluid that contains glycine. The symptoms are hidden during general anesthesia and severe hyponatremia can occur before the syndrome is detected. RésuméObjectif L'hyponatre´mie se´ve`re est associe´e à un taux de mortalite´e´leve´. Elle peut survenir lors d'interventions impliquant une irrigation avec une solution de glycine. É léments cliniques Il s'agit d'une patiente de 31 ans subissant une re´section d'un myome ute´rin par re´section endoscopique sous anesthe´sie ge´ne´rale. Apre`s 35 min de chirurgie, on note une bradycardie a`41 min -1 avec hypertension arte´rielle a`150/86 mmHg suivie d'un bronchospasme accompagnant un oede`me pulmonaire avec de´saturation a`90 %, augmentation de la pression des voies ae´riennes a`50 cmH 2 O, une pression partielle de CO 2 expire´a`49 mmHg, une natre´mie a`100 mmol Á L -1 et un bilan hydrique du liquide d'irrigation ne´gatif de 3000 mL. L'administration de 600 mL de se´rum sale´hypertonique a3 %, l'injection de furose´mide 60 mg, une ponction transvaginale e´vacuatrice du liquide extravase´en intrape´ritone´al, ainsi qu'une ventilation artificielle durant 6 h conduisent a`une e´volution favorable. Conclusion Le syndrome de re´sorption au de´cours de la re´section endoscopique d'un myome ute´rin est lie´au passage dans le sang du liquide d'irrigation contenant de la glycine. Les symptômes sont masque´s au cours de l'anesthe´sie ge´ne´rale et une hyponatre´mie se´ve`re peut survenir avant que le syndrome soit de´tecte´.

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“…Conversely, its correction may also cause severe morbidity and mortality 4,5 . Although the subject has been intensively reviewed, practical diagnosis and treatment remains problematic: Hyponatremia is widely under‐diagnosed 6 ; symptomatic hyponatremia is induced in the hospitalized patient, diagnosis is delayed and treatment is inadequate 7 ; diagnosis and initial treatment is random 8 ; patients are dying of iatrogenic hyponatremia 9,10 ; and otherwise healthy individuals are dying of hyponatremia 11 …”

Section: Cerebral Symptoms In Hyponatremiamentioning

confidence: 99%

Initial approach to the hyponatremic patient

Overgaard-Steensen

2010

Acta Anaesthesiologica Scandinavica

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The conflict between previously opposing standpoints is gradually giving way to an emerging consensus: Prompt bolus treatment of symptomatic hyponatremia with hypertonic saline. After the initial treatment, overcorrection must be avoided. Definitive treatment should be directed toward the nature of the underlying disorder. An approach based on the mechanism governing the impaired urine dilution has been proposed.

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Fatal hyponatremia in a 7-year-old girl with cloacal exstrophy after cystoscopy for a bladder stone

Cited by 5 publications

References 5 publications

Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

Severe hyponatremia associated with transcervical resection of a uterine myoma

Initial approach to the hyponatremic patient

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