{"title":"Death from Acute Hyponatremia Following Uneventful Abdominal Hysterectomy: Lessons from a Case Report","authors":"G. Vilos","doi":"10.33552/WJGWH.2019.02.000541","DOIUrl":null,"url":null,"abstract":"A 38-year-old woman underwent a routine/uneventful abdominal hysterectomy for abnormal uterine bleeding (AUB) and uterine fibroids. Approximately 24 hours later, she developed severe hyponatremia (Na = 118 mEq/L), brain edema and coma, and she died 3 days later. The mechanism of hyponatremia was, likely, due to excessive and/or inappropriate fluid infusion of 2/3:1/3 solution. The inability to regulate her fluids and electrolytes (Na and K), was, likely, related to addback estrogen therapy given for 3 months preoperatively in conjunction with a GnRH agonist to optimize the patient’s hemoglobin and shrink the uterus/fibroids. It has been known that postmenopausal women and men can regulate excessive hyponatremic fluid absorption and electrolytes better than premenopausal women implicating an estrogen role. Estrogen has been found to inhibit the Na/K-ATPase pump in a variety of tissues/organs including the brain. This woman’s pathology of the endometrium was reported as proliferative indicating that enough estrogen may have been available to inhibit her Na/K-ATPase pump resulting in inability to regulate her fluids and electrolytes leading to her death.","PeriodicalId":87379,"journal":{"name":"World journal of gynecology & womens health","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of gynecology & womens health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.33552/WJGWH.2019.02.000541","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2
Abstract
A 38-year-old woman underwent a routine/uneventful abdominal hysterectomy for abnormal uterine bleeding (AUB) and uterine fibroids. Approximately 24 hours later, she developed severe hyponatremia (Na = 118 mEq/L), brain edema and coma, and she died 3 days later. The mechanism of hyponatremia was, likely, due to excessive and/or inappropriate fluid infusion of 2/3:1/3 solution. The inability to regulate her fluids and electrolytes (Na and K), was, likely, related to addback estrogen therapy given for 3 months preoperatively in conjunction with a GnRH agonist to optimize the patient’s hemoglobin and shrink the uterus/fibroids. It has been known that postmenopausal women and men can regulate excessive hyponatremic fluid absorption and electrolytes better than premenopausal women implicating an estrogen role. Estrogen has been found to inhibit the Na/K-ATPase pump in a variety of tissues/organs including the brain. This woman’s pathology of the endometrium was reported as proliferative indicating that enough estrogen may have been available to inhibit her Na/K-ATPase pump resulting in inability to regulate her fluids and electrolytes leading to her death.
一位38岁的女性因异常子宫出血(AUB)和子宫肌瘤接受了常规/平稳的腹部子宫切除术。约24小时后,患者出现严重低钠血症(Na = 118 mEq/L)、脑水肿和昏迷,3天后死亡。低钠血症的机制可能是由于过量和/或不适当的液体输注2/3:1/3溶液。无法调节她的液体和电解质(钠和钾),可能与术前3个月的补品雌激素治疗联合GnRH激动剂以优化患者的血红蛋白和缩小子宫/肌瘤有关。众所周知,绝经后的女性和男性可以比绝经前的女性更好地调节过度的低钠血症液体吸收和电解质,这意味着雌激素的作用。雌激素已被发现可以抑制包括大脑在内的多种组织/器官中的Na/ k - atp酶泵。据报道,这名妇女的子宫内膜病理呈增生性,表明可能有足够的雌激素可用于抑制她的Na/ k - atp酶泵,导致无法调节她的液体和电解质,导致她死亡。