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

ABSTRACT

Hysteroscopy is an important diagnostic and therapeutic procedure that can cause serious complications, including uterine perforation and dilutional hyponatremia. Hyponatremia itself may cause central pontine myelinolysis, and pulmonary edema, 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 litres 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 edema was considered. The supportive treatment, mechanical ventilation and 3% hypertonic saline solution were used in the ICU. Initial 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 edema caused by excessive fluid overload during hysteroscopic surgery.