Management of acute symptomatic hyponatraemia

BMJ 1994;308:980 (9 April)

Letters

Management of acute symptomatic hyponatraemia

EDITOR, - Christopher Heneghan and colleagues discuss the managementof hyponatraemia during transurethral resection of the prostate.¹Having been a urologist throughout my career, since my retirementI have acted as reviewer for legal assessment firms. I havebeen impressed by certain recurring patterns that may be important.

Acute hyponatraemia after transurethral resection of the prostateis known to increase with the duration of the operation, which,with experienced operators, usually implies excessive venousbleeding that has been resistant to control. In many such casesin which litigation is threatened, a careful examination ofthe case notes reveals a record, sometimes tucked away in thenurse's or house officer's history, that the patient is takingdaily aspirin. Absence of a note does not rule this out. Dailyaspirin can be fatal. If the irrigant used contains mannitolor sorbitol (seldom nowadays) and the hyponatraemia is not immediatelyremedied, pulmonary oedema . . . [Full text of this article]