Intravascular spill of hyperosmolar urea during induced midtrimester abortion

Intravascular spill of hypertonic sodium chloride and the resultant serious and occasionally fatal consquences have been reported in association with induced midtrimester abortion. This report details 3 cases of intravascular spill of hyperosmolar urea. Although urea may pose less concern, because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. In addition, abnormal blood pigments may occasionally be noted in the urine. Treatment includes intravenous hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents.