Arieff A I, Ayus J C
Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA 94121.
JAMA. 1993 Sep 8;270(10):1230-2.
To investigate the occurrence of hyponatremic encephalopathy and the effects of therapy for symptomatic hyponatremia on outcome in women undergoing endometrial ablation.
Consultations from university-affiliated and community hospitals from June 1991 to June 1992.
Four generally healthy women who underwent elective endometrial ablation for dysfunctional bleeding and developed hyponatremic encephalopathy.
Three patients were promptly treated with hypertonic (514 mmol/L) sodium chloride such that the serum sodium level increased from 102 to 123 mmol/L within 24 hours. The fourth patient was not treated until after suffering grand mal seizures followed by respiratory arrest.
Of the four patients who developed hyponatremic encephalopathy, the diagnosis was established before respiratory arrest occurred in three. The operative procedure was terminated and all three were aggressively treated with intravenous hypertonic sodium chloride, which raised the serum sodium level to modestly hyponatremic levels (120 to 130 mmol/L). All three completely recovered without sequelae. The fourth patient suffered respiratory arrest before therapy could be initiated. The patient remained comatose, and central diabetes mellitus and insipidus developed. She never regained consciousness and died after several days. Autopsy revealed cerebral edema and tonsillar herniation.
The mean (+/- SD) preoperative serum sodium level was 138 +/- 1 mmol/L; at the time of diagnosis of hyponatremia, it was 107 +/- 13 mmol/L. In two patients, hyponatremic encephalopathy was diagnosed intraoperatively because of tremulousness and either hypothermia or hypoxemia. In the other two patients, the diagnosis was made postoperatively because of headache, nausea, emesis, and in one of these patients, respiratory arrest.
Women undergoing elective endometrial ablation can develop severe symptomatic hyponatremia, which can be fatal. The presence of symptoms suggesting hypo-osmolality should lead to immediate measurement of plasma sodium level. If hyponatremia with hypo-osmolality is present, early and appropriate therapy for the hyponatremia should be instituted before respiratory insufficiency occurs.
研究低钠血症性脑病的发生率以及有症状低钠血症的治疗对接受子宫内膜切除术的女性患者预后的影响。
1991年6月至1992年6月来自大学附属医院和社区医院的会诊病例。
4名一般健康的女性，因功能失调性子宫出血接受择期子宫内膜切除术，并发生了低钠血症性脑病。
3例患者迅速接受高渗（514 mmol/L）氯化钠治疗，使血清钠水平在24小时内从102 mmol/L升至123 mmol/L。第4例患者在发生癫痫大发作继而呼吸骤停后才接受治疗。
4例发生低钠血症性脑病的患者中，3例在呼吸骤停前确诊。手术终止，所有3例均接受静脉高渗氯化钠积极治疗，使血清钠水平升至轻度低钠水平（120至130 mmol/L）。所有3例均完全康复且无后遗症。第4例患者在开始治疗前发生呼吸骤停。该患者一直昏迷，并发中枢性尿崩症。她从未恢复意识，数天后死亡。尸检显示脑水肿和小脑扁桃体疝。
术前血清钠水平均值（±标准差）为138±1 mmol/L；诊断低钠血症时为107±13 mmol/L。2例患者术中因震颤及体温过低或低氧血症诊断为低钠血症性脑病。另外2例患者术后因头痛、恶心、呕吐确诊，其中1例还发生了呼吸骤停。
接受择期子宫内膜切除术的女性可能发生严重的有症状低钠血症，可导致死亡。出现提示低渗状态的症状应立即测定血浆钠水平。如果存在低渗性低钠血症，应在呼吸功能不全发生前尽早进行适当的低钠血症治疗。
