Agraharkar M, Agraharkar A
University of Connecticut Health Center, Farmington, USA.
Am J Kidney Dis. 1997 Nov;30(5):717-9. doi: 10.1016/s0272-6386(97)90499-6.
Hyponatremia, caused by absorption of hypotonic irrigating fluids, is a well-documented complication of surgical procedures such as transurethral resection of the prostate (TURP). Although not commonly mentioned in the renal literature, there have been several case reports of hyponatremia associated with hysteroscopic endometrial ablation that also were considered to be attributable to absorption of hypotonic fluid. We present a 43-year-old white woman who underwent endometrial ablation for menorrhagia under general anesthesia. Postoperative serum chemistries showed a sodium of 112 mEq/L and an osmolality of 234 mOsm/L, and urine chemistries showed a sodium of 125 mEq/L and an osmolality of 629 mOsm/L. Although fluid retention of hypotonic irrigating fluid clearly contributed to the hyponatremia, search for associated morbidity showed an absence of either osmotic or volume stimulus to account for the apparent antidiuretic effect, suggesting the participation of a postsurgical, stress-related ADH release. We conclude that hyponatremia associated with hysteroscopic endometrial ablation may be multifactorial.
低钠血症是经尿道前列腺切除术（TURP）等外科手术的一种有充分文献记载的并发症，由低渗冲洗液吸收所致。虽然在肾脏文献中不常提及，但已有几例与宫腔镜子宫内膜切除术相关的低钠血症病例报告，这些病例也被认为归因于低渗液的吸收。我们报告一例43岁白人女性，在全身麻醉下接受了因月经过多而行的子宫内膜切除术。术后血清化学检查显示钠浓度为112 mEq/L，渗透压为234 mOsm/L，尿液化学检查显示钠浓度为125 mEq/L，渗透压为629 mOsm/L。虽然低渗冲洗液的液体潴留显然导致了低钠血症，但对相关发病率的检查显示，不存在任何渗透压或容量刺激来解释明显的抗利尿作用，提示存在术后与应激相关的抗利尿激素释放。我们得出结论，与宫腔镜子宫内膜切除术相关的低钠血症可能是多因素的。
