A Case with Severe Hyponatremia during Hysteroscopic Myomectomy

Abstract

Water intoxication may be induced by the use of intrauterine fluid overload in hysteroscopic surgery. We report a patient with a uterine myoma and anemia (Hb, 9.3 g/dl), who developed severe hyponatremia during a hysteroscopic myomectomy. The submucosal myoma was resected using a monopolar resectoscope following 6 courses of GnRH agonist therapy. The procedure was performed by a combination of lumbar and intravenous anesthesia. The total amount of 3% solbitol was 27,000 ml and the duration of the procedure was 75 minutes. Severe hyponatremia (104 mEq/l) was diagnosed during the procedure, although there were no abnormal symptoms and vital signs. The serum Na level recovered to a normal level following the administration of diuretics. This case suggests that hyponatremia may occur during extensive resection of non-protruding submucosal myomas. Therefore, frequent measurements of intake and output of fluids and measurement of the serum Na level are required to prevent severe hyponatremia during hysteroscopic procedures for such cases.