Keywords
surgery
Perioperative Period
How to Cite
Abstract
Background: Postoperative hyponatremia is a frequent complication that is found in more than 4% of patients undergoing surgery. It is also an independent factor of in-hospital mortality. Until now, previous studies have focused on the first hours after surgery, so there is little information regarding hyponatremia in the late postoperative period.
Purpose: evaluate the frequency and characteristics of hyponatremia in the first postsurgical week.
Methodology: Patients undergoing major surgery over a period of 18 months were included. Sodium level was determined at 24 hours, third, fifth and seventh day of the procedure. Hyponatremia was classified according to surgery type and presence of clinical symptoms and outcomes were documented.
Results: 280 patients were studied. 20 (7.1%) developed hyponatremia on the first postoperative day, 34 (12.1%) on the third, 30 (10.7%) on the fifth day, and 31 (11%) on the seventh day. On the first postoperative day, patients undergoing urological and gastrointestinal surgeries developed hyponatremia more frequently. None of the patients developed serious complications. There was no relationship between age, gender or type of solutions and the development of hyponatremia.
Conclusions: hyponatremia is a frequent complication of surgical procedures that can develop in the first seven postoperative days.
References
Bagshaw SM, Townsend DR, McDermid RC. Disorders of sodium and water balance in hospitalized patients. Can J Anaesth. 2009 febr.;56(2):151-67. https://doi.org/10.1007/s12630-008-9017-2
Beukhof CM, Hoorn EJ, Lindemans J, Zietse R. Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol. 2007 mzo.;66(3):367-72. https://doi.org/10.1111/j.1365-2265.2007.02741.x
Gill G, Huda B, Boyd A, Skagen K, Wile D, Watson I, et al. Characteristics and mortality of severe hyponatraemia--a hospital-based study. Clin Endocrinol. 2006 ag.;65(2):246-9. https://doi.org/10.1111/j.1365-2265.2006.02583.x
Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant. 2006 en.;21(1):70-6. https://doi.org/10.1093/ndt/gfi082
Chung HM, Kluge R, Schrier RW, Anderson RJ. Postoperative hyponatremia. A prospective study. Arch Intern Med. 1986 febr. 1;146(2):333-6. https://doi.org/10.1001/archinte.146.2.333
Guy AJ, Michaels JA, Flear CT. Changes in the plasma sodium concentration after minor, moderate and major surgery. Br J Surg. 1987 nov. 1;74(11):1027-30. https://doi.org/10.1002/bjs.1800741123
Lane N, Allen K. Hyponatraemia after orthopaedic surgery. BMJ. 1999 my. 22;318(7195):1363-4. https://doi.org/10.1136/bmj.318.7195.1363
Severn AM, Dodds C. Hyponatraemia after orthopaedic surgery. BMJ. 1999 August 21, 1999;319(7208):514. https://doi.org/10.1136/bmj.319.7208.514
Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985 febr.;102(2):164-8. https://doi.org/10.7326/0003-4819-102-2-164
Ayus JC, Areiff AI. Postoperative Hyponatremia in Menstruant Women. Ann Intern Med. 1993 jun. 15;118(12):984-c-5. https://doi.org/10.7326/0003-4819-118-12-199306150-00017
Arieff AI, Ayus JC. Endometrial ablation complicated by fatal hyponatremic encephalopathy. JAMA. 1993 sept. 8;270(10):1230-2. https://doi.org/10.1001/jama.270.10.1230
Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000 my. 25;342(21):1581-9. https://doi.org/10.1056/NEJM200005253422107
Bohn D. Children are another group at risk of hyponatraemia perioperatively. BMJ. 1999 nov. 6;319(7219):1269. https://doi.org/10.1136/bmj.319.7219.1269
Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study. Pediatrics. 2004 my. 1;113(5):1279-84. https://doi.org/10.1542/peds.113.5.1279
Knochel JP. Hypoxia Is the Cause of Brain Damage in Hyponatremia. JAMA. 1999 jun. 23;281(24):2342-3. https://doi.org/10.1001/jama.281.24.2342
Bhananker SM, Paek R, Vavilala MS. Water Intoxication and Symptomatic Hyponatremia After Outpatient Surgery. Anesth Analg. 2004 my. 1;98(5):1294-6. https://doi.org/10.1213/01.ANE.0000114550.04698.E3
Fraser CL, Kucharczyk J, Arieff AI, Rollin C, Sarnacki P, Norman D. Sex differences result in increased morbidity from hyponatremia in female rats. Am J Physiol Regulatory Integrative Comp Physiol. 1989 abr. 1;256(4):R880-5. https://doi.org/10.1152/ajpregu.1989.256.4.R880
Ayus JC, Arieff AI. Pulmonary complications of hyponatremic encephalopathy. Noncardiogenic pulmonary edema and hypercapnic respiratory failure. Chest. 1995 febr. 1;107(2):517-21. https://doi.org/10.1378/chest.107.2.517
Arieff AI. Fatal Postoperative Pulmonary Edema: Pathogenesis and Literature Review. Chest. 1999 my. 1;115(5):1371-7. https://doi.org/10.1378/chest.115.5.1371
Ayus JC, Arieff AI. Brain damage and postoperative hyponatremia: the role of gender. Neurology. 1996 febr.;46(2):323-8. https://doi.org/10.1212/WNL.46.2.323
Effros RM. Respiratory consequences of postoperative hyponatremia in young women. Chest. 1995 febr. 1;107(2):300-1. https://doi.org/10.1378/chest.107.2.300
Sterns RH. Postoperative Hyponatremia in Menstruant Women. Ann Intern Med. 1993 jun. 15;118(12):984-b-5. https://doi.org/10.7326/0003-4819-118-12-199306150-00016
Bennani SL, Abouqal R, Zeggwagh AA, Madani N, Abidi K, Zekraoui A, et al. Incidence, causes and prognostic factors of hyponatremia in intensive care. Rev Med Interne. 2003 abr.;24(4):224-9. https://doi.org/10.1016/S0248-8663(02)00811-1
Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care. 2008;12(6):R162. https://doi.org/10.1186/cc7162
Eulmesekian PG, Perez A, Minces PG, Bohn D. Hospital-acquired hyponatremia in postoperative pediatric patients: prospective observational study. Pediatr Crit Care Med. 2010 jul.;11(4):479-83. https://doi.org/10.1097/PCC.0b013e3181ce7154
Stelfox HT, Ahmed SB, Zygun D, Khandwala F, Laupland K. Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery. Can J Anaesth. 2010 jul.;57(7):650-8. https://doi.org/10.1007/s12630-010-9309-1
Herrod PJ, Awad S, Redfern A, Morgan L, Lobo DN. Hypo- and hypernatraemia in surgical patients: is there room for improvement? World J Surg. 2010 mzo.;34(3):495-9. https://doi.org/10.1007/s00268-009-0374-y
Georgiadou T, Vasilakakis I, Meitanidou M, Georgiou M, Filippopoulos K, Kanakoudis F. Changes in serum sodium concentration after transurethral procedures. Int Urol Nephrol. 2007;39(3):887-91. https://doi.org/10.1007/s11255-006-9121-6
Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002 oct. 1;89(4):622-32. https://doi.org/10.1093/bja/aef220
Moritz ML, Ayus JC. Prevention of Hospital-Acquired Hyponatremia: A Case for Using Isotonic Saline. Pediatrics. 2003 febr. 1;111(2):227-30. https://doi.org/10.1542/peds.111.2.227
Fieldman NR, Forsling ML, Le Quesne LP. The effect of vasopressin on solute and water excretion during and after surgical operations. Ann Surg. 1985 mzo.;201(3):383-90. https://doi.org/10.1097/00000658-198503000-00022
Kelly DF, Laws ER, Fossett D. Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. Report of nine cases. J Neurosurg. 1995 ag.;83(2):363-7. https://doi.org/10.3171/jns.1995.83.2.0363
Zada G, Liu CY, Fishback D, Singer PA, Weiss MH. Recognition and management of delayed hyponatremia following transsphenoidal pituitary surgery. J Neurosurg. 2007 en.;106(1):66-71. https://doi.org/10.3171/jns.2007.106.1.66
Moritz ML, Ayus JC. The pathophysiology and treatment of hyponatraemic encephalopathy: an update. Nephrol Dial Transplant. 2003 dic. 1;18(12):2486-91. https://doi.org/10.1093/ndt/gfg394
Steele A, Gowrishankar M, Abrahamson S, Mazer D, Feldman RD, Halperin M. Postoperative Hyponatremia despite Near-Isotonic Saline Infusion: A Phenomenon of Desalination. Ann Intern Med. 1997 en. 1;126(1):20-5. https://doi.org/10.7326/0003-4819-126-1-199701010-00003
Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. 1986 jun. 12;314(24):1529-35. https://doi.org/10.1056/NEJM198606123142401
Chow KM, Kwan BC, Szeto CC. Clinical studies of thiazide-induced hyponatremia. J Natl Med Assoc. 2004 oct.;96(10):1305-8.
Silva JM, Barros MA, Chahda MA, Martins-Santos I, Yoiti L, Sá L. Factores de riesgo para complicaciones perioperatorias en cirugías endoscópicas con irrigación. Rev Bras Anestesiol. 2013;63(4):327-33. https://doi.org/10.1016/j.bjan.2012.07.001
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.