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Q J Med 2002; 95: 321-330
© 2002 Association of Physicians

Masterclasses in medicine

Hyponatraemia and hyperglycaemia during laproscopic surgery

M.R. Davids1, S.-H. Lin2, Y. Edoute3, S. Cheema-Dhadli4 and M.L. Halperin4,

1 From the Nephrology Unit and Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa, 2 Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense National Center, Taipei, Taiwan, 3 Internal Medicine C, Rambam Medical Center, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel, and 4 Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Canada

Summary

The aim of this masterclass is to develop a rational plan of therapy to deal with a severe degree of hyponatraemia (90 mmol/l) and hyperglycaemia (100 mmol/l) that occurred 100 min after the start of laproscopic surgery in a young woman. The lavage fluid used in this procedure was 10% dextrose.H2O in water (505 mmol glucose/l). To focus attention on specific issues, three questions are posed to the reader, as they were to a panel of 59 modern-day experts. Two imaginary consultants from the past were asked the same (and additional) questions. Their responses were restricted to knowledge available before the molecular era, to show the power of integrative physiology at the bedside. An analysis of intracellular events was helpful in answering the first question: ‘Is an infusion of hypertonic saline required to treat her acute hyponatremia?’ Similarly, a quantitative analysis of changes in the composition of the extracellular fluid compartment was helpful in answering the second question: ‘Is an infusion of isotonic saline required to treat her hypotension?’ A metabolic analysis was used to answer the third question, ‘Should insulin be administered?’

Notes

Address correspondence to Professor M.L. Halperin, Professor of Medicine, University of Toronto, St Michael's Hospital Annex, Lab #1, Research Wing, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada. e-mail: mitchell.halperin{at}utoronto.ca


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D.Z.I. Cherney, M.R. Davids, and M.L. Halperin
Acute hyponatraemia and 'ecstasy': insights from a quantitative and integrative analysis
QJM, July 1, 2002; 95(7): 475 - 483.
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