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Patient Profiles

Postoperative Hyponatremia

42-year-old female with no significant medical history is status post hysterectomy for treatment of uterine fibroids. Preoperative serum sodium was 142 mEq/L. On postoperative day 2, the patient was noted to be confused and irritable with a serum sodium of 125 mEq/L. The patient was transferred to the ICU for treatment.

Postoperative exam
  • The patient’s intraoperative course was uneventful; blood loss during the 2-hour procedure was 500 cc. This 60-kg patient received a total of 4.5 L of hypotonic IV fluid (0.45% NaCl). No blood replacement was necessary
  • Following the procedure, the patient was oriented and complained of pain at the incision site and severe nausea
  • Vital signs: BP 128/90, pulse 96, afebrile
  • The patient was treated with IV morphine for pain and ondansetron for nausea
Postoperative day 2
  • On the evening of postoperative day 2, the patient was noted by floor nurses to be hallucinating and combative
Postoperative Day 2: Laboratory Values
Serum [Na+]
(normal: 135-145 mEq/L)		 125 mEq/L
Serum [K+]
(normal: 4.0-4.7 mEq/L)		 4.0 mEq/L
Cl
(normal: 96-106 mEq/L)		 65 mEq/L
CO2
(normal: 20-29 mmol/L)		 20-29 mmol/L
BUN
(normal: 10-20 mg/dL)		 10 mg/dL
Creatinine
(normal: 0.6-1.2 mg/dL)		 0.6 mg/dL
Glucose
(normal: ≤100 mg/dL)		 90 mg/dL

Neurological exam
  • Confused, agitated, and irritable, with no focal neurological deficits

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