During hysteroscopic myomectomy for a 4 cm Type 0 submucous fibroid using glycine 1.5% as distension medium, the fluid deficit reaches 1500 mL. The patient becomes confused and hypertensive. What is the most likely underlying pathophysiology?

• A Acute hyponatremia causing cerebral edema ✓
• B Hyperglycemia causing osmotic diuresis
• C Air embolism from venous sinus opening
• D Anaphylaxis to glycine metabolite ammonia

Explanation

Absorption of large volumes of hypotonic distension medium (glycine 1.5%) during hysteroscopic surgery causes acute dilutional hyponatremia, leading to cerebral edema and neurological symptoms including confusion and hypertension. B fluid deficit exceeding 1000 mL with hypotonic solutions warrants stopping the procedure, checking serum sodium, and considering hypertonic saline if severe. Normal saline is preferred when bipolar energy is used.

Reference: Te Linde's Operative Gynecology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.