To the Editor.
—In the article entitled "Endometrial Ablation Complicated by Fatal Hyponatremic Encephalopathy," Drs Arieff and Ayus1 again direct our attention to the severe danger of hypotonic overhydration in menstruant women. In contrast to their previous report2 where emphasis had been placed on the postoperative occurrence of this syndrome, the current study clearly implicates the operative procedure itself where, as with transurethral resection of the prostate (TURP), severe dilutional hyponatremia can occur. Both procedures require the use of nonhemolytic salt-free irrigating solutions at pressures above that of the venous circulation, making possible vascular intrusion as venous channels are encountered.Gynecologists are relying on intake-output measurements to call attention to irrigant overload. Urologists have never been able to trust such measurements fully, and the four reported cases would seem to confirm the urologists' experiences. Endometrial ablation may be even more demanding and risky than TURP if success requires
Lyon RP. Hyponatremic Encephalopathy After Endometrial Ablation. JAMA. 1994;271(5):343. doi:10.1001/jama.1994.03510290025015