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AMBULATORY ANESTHESIA

Water Intoxication and Symptomatic Hyponatremia After Outpatient Surgery

Sanjay M. Bhananker, MD FRCA^*, Robert Paek, MD^*, and Monica S. Vavilala, MD^*,

Departments of *Anesthesiology and Pediatrics, University of Washington School of Medicine, Seattle, Washington

Address correspondence and reprint requests to Sanjay M. Bhananker, MD, FRCA, Department of Anesthesiology, Harborview Medical Center, 325 9th Ave., Seattle, WA 98104. Address e-mail to sbhanank{at}u.washington.edu

Severe hyponatremia is associated with a mortality rate of more than 50%, primarily from cerebral edema and central nervous system dysfunction. Water intoxication is an unusual but potentially lethal cause of perioperative hyponatremia. We report a patient with severe postoperative hyponatremia resulting from excessive perioperative water consumption. Anesthesiologists should maintain an index of suspicion for hyponatremia from water intoxication in patients with neurologic symptoms during the perioperative period. Routine preoperative instructions regarding maximum perioperative water intake and inquiry into any concurrent alternative medical therapies may help to avoid this preventable complication.

IMPLICATIONS: Water intoxication is an unusual but potentially lethal cause of perioperative hyponatremia. We report a patient with severe postoperative hyponatremia resulting from excess perioperative water consumption.