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

Abstract

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.

Clinical aspects of symptomatic hyponatremia

“…Resorbing irrigate fluids in e.g. transurethral prostate surgery ( 48 ), hysteroscopic surgery ( 49 ) or during preparation for colonoscopy ( 50 ) can cause acute HN. Usually, a normal sNA level from the same day or the day before will document the acute fall in sNA.…”

“…Usually, a normal sNA level from the same day or the day before will document the acute fall in sNA. In one patient, even correction of sNA from 74 mmol/L to 130 mmol/L within 7 h was reported without the occurrence of neurologic deficits ( 49 ). In this case, pulmonary edema developed during hysteroscopic surgery together with an acute drop in sNA.…”

“…Correction was achieved by the administration of furosemide 40 mg together with the infusion of 500 mL of 3% hypertonic saline for 1 h (sNA was 103 mmol/L thereafter) followed by the infusion of 3% hypertonic saline for additional 6 h (50 mL/h). Hepp and coworkers also reported 8 additional cases from the literature of which 4 were treated with 3% saline ( 49 ). The other 4 patients were treated with 7%, 2%, isotonic saline or furosemide, respectively.…”

Complicaciones asociadas con la histeroscopia

“…33 Un estudio realizado en Reino Unido encontró que muchas de las complicaciones se debían a factores humanos, porque no se practicaba el examen vaginal previo en 67% de los casos, posterior en 35.8% y realizaban el lavado en 9%; es así como ante el bajo riesgo de complicaciones en la histeroscopia, se demuestra que es necesario tomar mayor conciencia sobre los mismos y establecer protocolos para su realización segura. 34 Por otro lado, la literatura es concisa al explicar el riesgo adicional representado por los diferentes tipos de energía y medios de distensión utilizados, el cual se ve incrementado con la técnica de energía monopolar que se confirmó con el elevado porcentaje de hiponatremia reflejado en los estudios comparativos analizados.…”

Severe hyponatremia with seizures and confirmed mild brain edema by hysteroscopic myomectomy: a case report

“…Hyponatremia is a severe complication of hysteroscopic myomectomy, caused by the absorption of fluid media used for uterine distension via damaged blood vessel and myometrium [1][2][3][4][5][6][7]. Absorption of an electrolyte-free fluid media can decrease the plasma colloid osmotic pressure, which results in fluid movement from intravascular to extravascular space.…”