LETTER
Postoperative Hyponatremia in Menstruant Women
Stephen D. Fillman
15 June 1993 | Volume 118 Issue 12 | Pages 984-985
TO THE EDITOR:
A 1986 article by Arieff [1] and a 1990 report by Fraser and Arieff [2] describe postoperative hyponatremic encephalopathy in premenopausal women. The recent article by Ayus, Wheeler, and Arieff [3] states that nearly half of their 65 patients with hyponatremic encephalopathy were from hospitals affiliated with either Baylor University or the University of California. This suggests that physicians were unaware of this syndrome, despite the recent articles by their own faculty.
If this catastrophic event is to be prevented, then all physicians who treat patients after surgery or write postoperative intravenous fluid orders must be made aware of the need to use only isotonic fluids in premenopausal women during the postoperative period.
I suggest that these authors contact the Food and Drug Administration (FDA), especially the editors of the FDA Drug Bulletin and have a warning published. None has been published to date. The FDA's Adverse Drug Department has received few reports other than a case I reported to them in 1991. Obviously, it is not common knowledge, because it is still happening at university medical centers.
1. Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. 1986; 314:1529-35.
2. Fraser CL, Arieff AI. Fatal diabetes mellitus and insipidus, resulting from untreated hyponatremia: new syndrome. Ann Intern Med. 1990; 112:113-9.
3. Ayus JD, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. 1992; 117: 891-7.
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