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February 2, 1994

Hyponatremic Encephalopathy After Endometrial Ablation

JAMA. 1994;271(5):345. doi:10.1001/jama.1994.03510290025021

To the Editor.  —We read with interest the article by Drs Arieff and Ayus1 describing severe symptomatic hyponatremia in four patients who underwent endometrial ablation. In two of these patients, the hyponatremic encephalopathy was diagnosed intraoperatively because of hypothermia or hypoxemia. Arieff and Ayus therefore suggested that in patients undergoing general anesthesia during endometrial ablation the possibility of hypo-osmolality should be suspected if, among other symptoms, a decrease in oxygen saturation is diagnosed by pulse oximeter. We have recently reported2 the occurrence of oxygen desaturation accompanied by a simultaneous increase in blood carbon dioxide levels in six of 46 patients who underwent operative hysteroscopy during a 6-month period. Moderate hyponatremic serum levels (121 and 125 mmol/L) were observed in only two of six patients. However, four of these patients were found to have a significant blood coagulopathy. Arieff and Ayus do not report the coagulation functions of their