Symptomatic Hyponatremia in Patients Undergoing Total Hip and Knee Arthroplasty
A Report of Three Cases
George S. Gluck, MD; Paul F. Lachiewicz, MD

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.

Hyponatremia has been reported as a complication after scoliosis procedures4,5 and adult lumbar spine fusions6. To our knowledge, there has been only one report of symptomatic hyponatremia after total hip arthroplasty7 and one after total knee arthroplasty8. We are also aware of one report of tramadol-induced hyponatremia following unicompartmental knee arthroplasty9, although asymptomatic hyponatremia occurs in patients undergoing lower extremity arthroplasty. In a review of 408 consecutive patients who had a lower extremity joint arthroplasty, twenty-one patients (5.1%) had asymptomatic hyponatremia (a serum sodium level of ≤130 mmol/L) postoperatively10.

We report three cases of clinically symptomatic hyponatremia, treated over a five-year period, that presented as severe postoperative confusion in patients who had had an elective total hip or total knee arthroplasty. Two of three patients were informed that information concerning their care would be submitted for publication. The …

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