An interesting case of acute, severe postoperative hyponatraemia following carotid endarterectomy

Parkinson, Fran; Hopper, Andrew N.; Eggert, Sabine

doi:10.1136/bcr-2012-008299

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…Previously, only three cases of significant hyponatremia following CEA have been reported. [2][3][4] Of these, only one report described severe hyponatremia with a sodium of 119 mmol/L. Unlike previous cases, our patient developed profound hyponatremia with a sodium level of 109 mmol/L.…”

Section: Discussioncontrasting

confidence: 63%

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A rare case of neurological dysfunction due to severe hyponatremia after carotid artery endarterectomy: A review of the clinical approach to hyponatremia

Ferrero

Ward

Groff

et al. 2021

Clinical Case Reports

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Section: Discussioncontrasting

confidence: 63%

“…This case highlights the need for heightened vigilance for the possibility of hyponatremia as the cause of neurological dysfunction after CEA. Previously, only three cases of significant hyponatremia following CEA have been reported 2–4 . Of these, only one report described severe hyponatremia with a sodium of 119 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

A rare case of neurological dysfunction due to severe hyponatremia after carotid artery endarterectomy: A review of the clinical approach to hyponatremia

Ferrero

Ward

Groff

et al. 2021

Clinical Case Reports

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“…2 It usually reflects a state of excess body water relative to sodium either because of dilution of sodium levels by excess water or by losses of sodium exceeding that of water. 3 Severe hyponatraemia is defined as a serum sodium <125 mmol/L and has been observed in around 1% of patients.…”

Section: Discussionmentioning

confidence: 99%

Hyponatraemic seizures following prostate brachytherapy

Slevin¹,

Rodda²,

Bosomworth³

et al. 2014

J Radiother Pract

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Aim: To demonstrate the importance of fluid management in the perioperative period by presenting a case of hyponatraemic seizures following prostate brachytherapy.Case: A 61-year-old gentleman, who had prostate cancer but was otherwise well, developed confusion and word-finding difficulties the day after prostate brachytherapy. This was followed by tonic-clonic seizures that necessitated treatment, intubation and ventilation, and admission to the intensive care unit. Investigations revealed serum sodium of 116 mmol/L. Fluid balance was inadequately recorded, but the patient had drank more than 3 L of water before he developed hyponatraemia.Discussion: Postoperative severe hyponatraemia and hyponatraemic encephalopathy develop because of anti-diuretic hormone release and hypotonic fluid administration. These are medical emergencies and should be managed in an intensive care unit. Symptoms range from headache, nausea and confusion to seizures, respiratory arrest and death, and are related to cerebral oedema. Treatment is done using hypertonic sodium chloride to increase the serum sodium to safe levels. Care should be taken to avoid overly rapid correction of serum sodium. Complete documentation of fluid balance is essential to allow proper assessment of fluid status. Patients should be advised on appropriate oral fluids in the postoperative period.Key words: Hyponatraemia; prostate brachytherapy; seizures CASE A 61-year-old gentleman with locally advanced prostate adenocarcinoma was treated with highdose rate (HDR) brachytherapy under general anaesthesia. He was on hormone manipulation with Bicalutamide for prostate cancer, but was otherwise well and took no other regular medication. As part of the general anaesthesia and preoperative medications during HDR brachytherapy, he was administered Propofol 160 mg, Fentanyl 100 μg, Ondansetron 4 mg, Gentamicin 160 mg and Rocuronium 30 mg. About 2 L of compound sodium lactate were administered intravenously.Overnight, after the procedure, the patient vomited around 1,000 mL in total and was noted to have low blood pressure (96/62 mmHg). Urine output from the urinary catheter decreased. Bladder scan demonstrated no residual volume. He was encouraged to increase his oral intake of fluid and was retrospectively noted in nursing documents to have drunk more than 3 L of water over Correspondence to: Finbar Slevin,

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Hyponatremia accompanying volatile hypertension caused by baroreflex failure after neck surgery: case report and literature review

Sarafidis¹,

Theodorakopoulou²,

Δίπλα

et al. 2020

Journal of Hypertension

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The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hyponatremia, and many disorders have been associated with it. Baroreflex failure is a rare disorder characterized by extreme blood pressure (BP) fluctuations, most frequently caused by neck or head trauma and irradiation. We report a case of a 48-year-old patient referred to our department for asymptomatic hyponatremia and volatile hypertension. His past medical history included nasopharyngeal carcinoma treated with surgery and bilateral neck radiation. Following the diagnostic algorithm for hyponatremia, the diagnosis of SIADH was made. Ambulatory BP monitoring revealed highly variable BP; extensive autonomic nervous system function testing suggested baroreflex-cardiovagal failure. We propose the hypothesis that not only labile hypertension because of baroreflex failure but also hyponatremia can develop as a late consequence of neck trauma and irradiation.

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An interesting case of acute, severe postoperative hyponatraemia following carotid endarterectomy

Cited by 5 publications

References 6 publications

A rare case of neurological dysfunction due to severe hyponatremia after carotid artery endarterectomy: A review of the clinical approach to hyponatremia

A rare case of neurological dysfunction due to severe hyponatremia after carotid artery endarterectomy: A review of the clinical approach to hyponatremia

Hyponatraemic seizures following prostate brachytherapy

Hyponatremia accompanying volatile hypertension caused by baroreflex failure after neck surgery: case report and literature review

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