Endometrial ablation complicated by fatal hyponatremic encephalopathy

Area of Science:

• Gynecology
• Nephrology
• Neurology

Background:

• Endometrial ablation is a common procedure for dysfunctional uterine bleeding.
• Hyponatremia, a low serum sodium level, can occur as a complication of fluid absorption during hysteroscopy.
• Symptomatic hyponatremia can lead to severe neurological sequelae, including encephalopathy and death.

Purpose of the Study:

• To investigate the occurrence of hyponatremic encephalopathy following endometrial ablation.
• To evaluate the effectiveness of therapy for symptomatic hyponatremia in this patient population.

Main Methods:

• A case series of four women who developed hyponatremic encephalopathy after endometrial ablation.
• Review of clinical data, including serum sodium levels, symptoms, and treatment interventions.
• Comparison of outcomes between patients treated promptly and those with delayed treatment.

Main Results:

• All four patients developed symptomatic hyponatremia, with mean serum sodium dropping from 138 to 107 mmol/L.
• Three patients diagnosed intraoperatively or postoperatively showed symptoms like tremulousness, hypothermia, headache, and nausea.
• Prompt treatment with hypertonic saline resulted in complete recovery for three patients; the fourth patient, with delayed treatment, suffered respiratory arrest, coma, and ultimately died.

Conclusions:

• Endometrial ablation poses a risk of severe symptomatic hyponatremia and hyponatremic encephalopathy.
• Early recognition of symptoms suggestive of hypo-osmolality is critical.
• Immediate measurement of plasma sodium levels and prompt, appropriate treatment of hyponatremia are essential to prevent fatal outcomes.