Gonzales R, Brensilver J M, Rovinsky J J
Department of Medicine, New Rochelle Hospital Medical Center, NY.
Am J Kidney Dis. 1994 May;23(5):735-8. doi: 10.1016/s0272-6386(12)70286-x.
We report a case of severe hyponatremia following hysteroscopic myomectomy for uterine fibroids. This new technique, which requires large volumes of irrigation solution (1.5% glycine in this case), is being more widely applied as an alternative to open surgery. Thus, nephrologists may expect to encounter such cases as the female counterpart to transurethral resection of prostate-associated hyponatremia. Analysis of the dynamic features of this case, in the context of recent knowledge of glycine metabolism, suggests that the early severe hyponatremia is partly spurious, reflecting an osmotic effect of glycine (which is initially restricted to the extracellular space). As glycine progressively enters cells and is metabolized, the later phase of hyponatremia more accurately reflects true hypo-osmolality.
我们报告了一例子宫肌瘤宫腔镜肌瘤切除术后发生严重低钠血症的病例。这种新技术需要大量冲洗液（本例中为1.5%甘氨酸），作为开放手术的替代方法正被更广泛地应用。因此，肾病学家可能会遇到此类病例，就如同经尿道前列腺切除术相关低钠血症在女性中的对应情况。结合最近关于甘氨酸代谢的知识对该病例的动态特征进行分析表明，早期严重低钠血症部分是假性的，反映了甘氨酸的渗透作用（最初仅限于细胞外空间）。随着甘氨酸逐渐进入细胞并被代谢，低钠血症的后期阶段更准确地反映了真正的低渗状态。
