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Case Report



Severe Pulmonary Edema due to Hyponatremia after Hysteroscopy; Rapid and Full Recovery

Akcan Akkaya, Ahmet Karatas, Abdullah Demirhan, Tulay Ozlu, Murat Bilgi, Ümit Yasar Tekelioglu, Kadir Akkaya.

Abstract
Hysteroscopy is an important diagnostic and therapotic procedure that can cause serious complications, including uterine perforation and dilutional hyponatremia. Hyponatremia itself may cause central pontine myelinolysis, and pulmonary eudema, which could be dangerous.

We report a patient who developed near fatal pulmonary edema, and hyponatremia during hysteroscopy. A total of 12 L irrigation fluid was given in 45 minutes and eight liters were collected. At the end of the procedure, the patient was suddenly being desaturated (Saturation O2 < %50) and huge amount of frothy fluid had come out of laryngeal mask airway, pulmonary eudema was considered. The supportive treatment, mechanical ventilation and 3% hipertonic saline solution were used in the ICU. Inital sodium levels were below the value of 100mEq/L but after 12 hours it was reached 135mEq/L. At the 17th hour she was extubated and day after she healed completely. This case report emphasizes the importance of rapid correction of hyponatremia and pulmonary eudema caused by excessive fluid overload during hysteroscopic surgery.

Key words: Hysteroscopy, Hyponatremia, Pulmonary eudema, 3% Sodium chloride


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