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Symptomatic Hyponatremia in Patients Undergoing Total Hip and Knee ArthroplastyA 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
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Mar 01;90(3):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 surgery2,3. 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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    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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