Hyponatremic Encephalopathy After Endometrial Ablation

To the Editor. —The article by Drs Arieff and Ayus 1 on the complications of operative hysteroscopy provides yet another account of potentially life-threatening complications of a procedure that is gaining popularity. At Physicians' Daysurgery Center, an outpatient surgical unit in Dallas, Tex, we began performing hysteroscopic surgery in May 1992. Over the course of the first 7 months, 49 of these procedures were done. It became apparent that there was a high rate of complications related to fluid absorption, including three patients who developed pulmonary edema. As serial sodium determinations are a late indicator of fluid absorption and usually not available in a timely manner, and measurement of instillation and recovery of irrigant are difficult and unreliable, other methods need to be looked at to measure intraoperative fluid absorption. Investigators in Sweden have used ethanol-containing irrigation fluid, combined with end-tidal breath alcohol analysis for TURP. 2-5 Hulten et al 1 showed