Excessive Fluid Overload With Severe Hyponatremia, Cardiac Failure, and Cerebral Edema Complicating Hysteroscopic Myomectomy: A Case Report and Review of the Literature

Abstract

Use of hypotonic distension media during hysteroscopic surgery carries a risk of dilutional fluid overload and can lead to potentially disastrous life-threatening complications. Careful perioperative monitoring of fluid dynamics, in particular fluid deficit, is the key factor in determining fluid overload and can substantially reduce this risk.

We report a case of excessive fluid overload during hysteroscopic resection of a submucosal fibroid. Intravascular absorption of 6 L of glycine 1.5% resulted in perioperative acute cardiac failure, severe dilutional hyponatremia, and postoperative signs of cerebral edema. Rapid treatment with hypertonic saline, diuretics, and cardiac stimulants was initiated.

Awareness of the risk of fluid overload and early recognition, by guiding the surgeon with constant feedback about fluid absorption, are important in preventing a fatal outcome. Therefore, we emphasize the meticulous need for careful standard perioperative monitoring of fluid dynamics. This allows steps to be taken to prevent excessive absorption. Treatment can be instituted early and the most optimal postoperative care can be chosen.