Four cases of severe hyponatremia occurring during operative hysteroscopy and resulting in a 50% death rate are presented. Either glycine 1.5% or sorbitol 3% was used for uterine irrigation in each circumstance. Although careful monitoring of fluid intake and output is important, more precise methods of tracking medium intrusion into the vascular space may be required. Serial serum sodium, central venous pressure, and plasma osmolality determinations are recommended to establish a timely diagnosis of hyponatremia and hypoosmolality. Rapid and aggressive management of significant hyponatremia (Na < 120 mmol/liter) should be instituted using 3%-5% sodium chloride solution and furosemide to attain the goal of elevating serum sodium to 130\p=n-\135 mmol/liter with 24 h. Young women appear to be more susceptible to the sequelae of postoperative hyponatremia, e.g., cerebral edema, than are their male counterparts because of efficiency differences in their cerebral sodium pump function. Liquid distending media with osmolalities in the range of 280 mOsm/liter would offer a greater margin of patient safety than either sorbitol or glycine for operative hysteroscopy.(J GYNECOL SURG 9:137,1993)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.