[Severe hyponatremia associated with transcervical resection of a uterine myoma].

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 cmH2O increase in airway pressure and an expired CO2 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.