To the Editor.
—When surgical techniques are transplanted from one specialty to another there can be a lag in learning the appropriate treatment of associated complications. This appears to be the case in the article by Drs Arieff and Ayus1 with regard to the treatment of absorptive hyponatremia during endoscopic endometrial ablation. Four cases of symptomatic perioperative hyponatremia were reported, including one death due to cerebral herniation. All cases were treated with hypertonic saline, which was reported to improve serum sodium levels.Urologic experience with TURP has shown that the treatment of absorptive hyponatremia with hypertonic saline is contraindicated. The major complications of hyponatremia under these circumstances are related to cerebral edema and volume overload, both of which may be exacerbated by administration of hypertonic saline. The pathophysiologic process occurs because of excess free water rather than low total serum sodium. The proper treatment is therefore intravenous loop diuretics,
Morgentaler A. Hyponatremic Encephalopathy After Endometrial Ablation. JAMA. 1994;271(5):344. doi:10.1001/jama.1994.03510290025019