Life-Threatening Laryngeal Edema and Hyponatremia during Hysteroscopy

Wegmüller, Barbara; Hug, Kerstin; Buenzli, Charlotte Meier; Yuen, Bernd; Maggiorini, Marco; Rudiger, Alain

doi:10.1155/2011/140381

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…With the development of resectoscopes using bipolar current the use of isotonic electrolyte solutions such as Ringer’s lactate or 0.9% saline may be used as distension media 3. Systemic absorption of some of the distension fluid medium is expected, with the average amount of fluid absorbed during operative hysteroscopy cases being approximately 400–600 mL 4. Intravascular absorption of fluid is driven by (1) increasing the hydrostatic pressure gradient between the distension fluid and the vasculature, and (2) increasing the surface area of vascular beds exposed to the distension fluid.…”

Section: Discussionmentioning

confidence: 99%

“…OHIA syndrome can present with myriad signs and symptoms. Manifestations may include nausea, vomiting, headache, weakness, pulmonary edema, acute respiratory distress syndrome, laryngeal edema, cerebral edema, hyponatremia, hypocalcemia, diffuse intravascular coagulation and rhabdomyolysis 1,2,4,8,9. This condition is not uncommon and is usually transient and mild in severity; however, it can be life-threatening 10.…”

Section: Discussionmentioning

confidence: 99%

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Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Elegante

Hamera

Xiao

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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Operative hysteroscopy intravascular absorption syndrome is an iatrogenic syndrome caused by absorption of hypo-osmolar distension medium during hysteroscopy, which can lead to rapid hyponatremia with resulting cerebral and pulmonary edema. We present a case of a 47-year-old female who underwent hysteroscopic myomectomy at an outpatient ambulatory surgical center who was brought to the emergency department with dyspnea, hypoxia, and altered mental status. Workup showed hyponatremia with cerebral edema on computed tomography of the head and pulmonary edema on chest radiograph. The patient improved after resuscitation with intravenous saline and supplemental oxygen, and she was discharged home the next day.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Elegante

Hamera

Xiao

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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“…A correction rate of 25 mEq/L is generally recommended within 48 h until the sodium in the serum is above 120 mEq/L, but without reaching normal or hypernatremic levels [ 31 , 32 ]. Despite this, most publications report significantly higher correction rates [ 18 , 20 , 21 , 33 ], even correcting as rapidly as the initial sodium level decreased [ 27 ]. Encephalopathy or pontine myelysis did not occur in any of these cases and patients were reported to have recovered fully after therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Hepp

Jüttner²,

Beyer

et al. 2015

BMC Anesthesiol

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BackgroundOne 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.Case presentationHere 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.ConclusionThe 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.

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“…However, these hypoosmolar, electrolyte-free media can create fluid and electrolyte disturbances if absorbed in excess. 30,38 Neurological adverse events including hypotonic encephalopathy have been reported more often in reproductive aged women than in postmenopausal women. 37 The sodium-potassium ATP-ase pump is responsible for shunting sodium and, indirectly, water out of the cell.…”

Section: Low-viscosity Fluidsmentioning

confidence: 99%

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Munro

Christianson

2015

Clinical Obstetrics &Amp; Gynecology

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Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.

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Life-Threatening Laryngeal Edema and Hyponatremia during Hysteroscopy

Cited by 11 publications

References 18 publications

Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

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

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

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