JBJS | Symptomatic Hyponatremia in Patients Undergoing Total Hip and Knee Arthroplasty: A Report of Three Cases

The Journal of Bone & Joint Surgery, Volume 90, Issue 3

Case Reports | March 01, 2008

Symptomatic Hyponatremia in Patients Undergoing Total Hip and Knee Arthroplasty: A Report of Three Cases

George S. Gluck, MD¹; Paul F. Lachiewicz, MD¹

¹ Department of Orthopaedics, University of North Carolina at Chapel Hill, 3151 Bioinformatics Building, CB 7055, Chapel Hill, NC 27599-7055

The Journal of Bone & Joint Surgery. 2008; 90:634-636 doi:10.2106/JBJS.G.01403

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Clinically important hyponatremia is relatively uncommon. This disorder manifests with symptoms attributable to cerebral edema that include anorexia, nausea and vomiting, confusion, slurred speech, lethargy, weakness, agitation, headache, and seizures¹. Symptoms are generally seen in an acute setting (developing over forty-eight hours or less) with serum sodium levels at or below 125 mEq/L (125 mmol/L) or in the chronic setting with levels at or below 110 mEq/L (110 mmol/L)¹. If the disorder is left untreated or is corrected too rapidly, permanent neurologic sequelae can result. Surgical stress is recognized as a common cause of hyponatremia, most frequently in association with transplant, abdominal, cardiovascular, and orthopaedic trauma surgery^2,3. This electrolyte disorder is more commonly present in elderly female patients, in those with a lower body weight, and in those taking certain medications, such as thiazide diuretics and selective serotonin reuptake inhibitors².

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hyponatremia ; hip region ; hip joint ; knee replacement arthroplasty ; serum sodium level

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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