0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Postoperative Hyponatremic Encephalopathy in Menstruant Women

J. Carlos Ayus, MD; James M. Wheeler, MD, MPH; and Allen I. Arieff, MD
[+] Article and Author Information

Grant Support: In part by grant RO1AG08575 from the National Institute on Aging, Department of Health and Human Services, Bethesda, Maryland, and by the Research Service of the Veterans Affairs Medical Center, San Francisco, California.

Requests for Reprints: J. Carlos Ayus, MD, 4 Brompton Court, Houston, Texas 77024.

Current Author Addresses: Dr. Ayus: 4 Brompton Court, Houston, Texas 77024.

Dr. Wheeler: Department of Obstetrics and Gynecology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas 77030.

Dr. Arieff: Department of Medicine (111 G), Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121.


Ann Intern Med. 1992;117(11):891-897. doi:10.7326/0003-4819-117-11-891
Text Size: A A A

Objectives: To determine factors associated with the development of encephalopathy and with its clinical course in patients with postoperative hyponatremia.

Setting: Consultation and referral services of two university medical centers and community hospitals.

Design: Case-control study (risk factors for encephalopathy) and cohort study (clinical course among patients with encephalopathy).

Patients: Case patients included 65 adults with postoperative hyponatremic encephalopathy; controls included 674 adult patients who had postoperative hyponatremia without encephalopathy and who were selected from 76 678 consecutive adult surgical inpatients.

Measurements: Age, gender, menstrual status, neurologic symptoms, time to development and degree of hyponatremia, arterial blood gas determinations, serum chemistries, morbidity and mortality.

Results: Case patients included 40 women (62%) and 25 men (38%) (P > 0.05); controls included 367 women (54%) and 307 men (46%) (P > 0.1). Of the 34 case patients who developed permanent brain damage or died, 33 (97%) were women (P < 0.001). Among the women with brain damage, 25 (76%) were menstruant (P < 0.001). The relative risk for death or permanent brain damage from hyponatremic encephalopathy in women compared with men was 28 (95% Cl, 5 to 141) and in menstruant women compared with postmenopausal women, 26 (Cl, 11 to 62). Arterial PO2 at diagnosis was significantly lower in female than in male case patients (34 ± 5 compared with 91 ± 3 mm Hg; P < 0.001). Further, of the 38 case patients who had respiratory arrest before the diagnosis of hyponatremic encephalopathy, 36 (95%) were women. Extent of or time to development of hyponatremia did not correlate with subsequent brain damage (P > 0.1).

Conclusions: Women and men are equally likely to develop hyponatremia and hyponatremic encephalopathy after surgery. However, when hyponatremic encephalopathy develops, menstruant women are about 25 times more likely to die or have permanent brain damage compared with either men or postmenopausal women.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)