Brain damage and postoperative hyponatremia

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Abstract
Postoperative hyponatremia is a common clinical problem in the United States and western Europe, with an occurrence of 1% to 5%. [10-12] Death from postoperative hyponatremia was initially reported in the mid-1930s, [13] and there have been multiple subsequent reports of such patients dying or suffering permanent brain damage. [14-17] There has been an increasing awareness that postoperative hyponatremia can lead to death or permanent brain damage following elective surgery in generally healthy adults. *RF 1-4,6-10,18 19* However, hyponatremia may be unsuspected as the cause of death or brain damage. Patients typically have a prodrome of headache, nausea, emesis, and weakness, and because such symptoms are somewhat nonspecific, they are often thought to be associated with the postoperative state. Respiratory insufficiency, manifested by either respiratory arrest or pulmonary edema, is often the initial manifestation of hyponatremic encephalopathy. [20] Respiratory insufficiency is often associated with grand mal seizures or sudden obtundation. [7]