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February 2, 1994

Hyponatremic Encephalopathy After Endometrial Ablation

Author Affiliations

University of Pennsylvania School of Medicine Philadelphia

JAMA. 1994;271(5):344. doi:10.1001/jama.1994.03510290025018

To the Editor.  —In their report on endometrial ablation complicated by fatal hyponatremic encephalopathy, Drs Arieff and Ayus1 failed to mention that prophylaxis against this complication is the simple expedient of monitoring the difference between inflow and outflow during surgery with the deficit assumed to be intravasation. In an article in press,2 we report that intravasation is more likely to occur in procedures that are of long duration, use considerable volumes of inflow, and are associated with increased bleeding. In that prospective, double-blinded, placebo-controlled study, vasopressin used at the outset was helpful in reducing intravasation.More important, however, is our disagreement over the method of therapy suggested in the article. These patients are not sodium depleted; they are water overloaded. Total body content of sodium is within normal limits. Therefore, treatment with hypertonic saline may compound the problem with respect to hypervolemia even though serum sodium levels become

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