Severe Mannitol-Induced Hyponatremia Complicating Transurethral Prostatic Resection

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Abstract
A case is presented in which the absorption of mannitol irrigation solution across prostatic veins resulted in severe hyponatremia in a patient undergoing transurethral prostatic resection. Since hyposmolality of the extracellular fluid was not seen because of the presence of mannitol the patient was asymptomatic despite a rapid decrease in the serum Na concentration to 99 milliequivalents/l. The importance of distinguishing dilutional hyponatremia from hyponatremia with normal or elevated osmolality is discussed.