Erdem, Ali Fuat Sakarya Eğitim Araştırma Hastanesi - Anesteziyoloji ve Reanimasyon AD, Turkey , İnce, İlker Atatürk üniversitesi - Tıp fakültesi - Anesteziyoloji ve Reanimasyon AD, Turkey , Dostbil, Ayşenur Atatürk üniversitesi - Tıp fakültesi - Anesteziyoloji ve Reanimasyon AD, Turkey , Çelik, Mine Atatürk Üniversitesi - Tıp Fakültesi - Anesteziyoloji ve Reanimasyon AD, Turkey , Öztürk, Gürkan Atatürk üniversitesi - Tıp fakültesi - Genel cerrahi AD, Turkey , Aydınlı, Bülent Atatürk üniversitesi - Tıp fakültesi - Genel cerrahi AD, Turkey , Doğan, Nazım Atatürk üniversitesi - Tıp fakültesi - Anesteziyoloji ve Reanimasyon AD, Turkey

Hypernatremia during hepatic hydatic cyst surgery

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Purpose:We intend to present a case of intraoperative hypernatria caused by hypertonic saline, one of the most commonly used skolosidal agents in the surgical treatment of hydatic cyst Case: 22 year old, 62 kg, female patient with ASA I condition (normal healthy patient) and with a large number of cysts in the liver, spleen and right kidney in each one hydatic cyst lesion, was placed an epidural catheter at T10-T11 level after following the routine monitoring. The patient was intubated after induction of anesthesia and muscle relaxation. As the surgical team bring out to use plenty of %20 hypertonic saline , %5 dextrose for intraoperative fluid replacement was given. After the splenectomy, 20% of saline was injected into the 20 cyst hydatit lesions in the right kidney and liver. After the drainage of the cyst in the kidney, Na value was measured 142 mEq/L and the blood sugar 274 mg/dL. Crystalized Insulin infusion started.After beginning the drainage from the cysts in the liver, Na value was 154 at 60. minute, and as it get up to 163 mEq/L at 120. minute, they began to give 50 ml / h tap water through a nasogastric probe . 2000 ml of 20% saline was used during the 4-hour operation. The patient was taken intubated to the intensive care and was sedated with propofol. As the Na value was168 mEq/L postoperatively 1 hour, it was decided to lull the patient. İt was planned to replace the fluit deficit which was calculated as 6200 ml, caused from hypernatremia, in 48 hours with 100 ml / h of 5% dextrose and 50ml/h tap water with a nasogastric tube. As the Na value was 163 postoperative 6. hour, 158 mEq/L 12. hour and 149 mEq/L 18. hour, the tap water through the nasogastric tube was cut. The Na value was posoperative 24.hour 147 mEq/L, so the sedation was cut and the patient was extubated with GKR 15 at the 26. hour. The patient removed from intensive care to the service on posoperative 3. day and was discharged at the 7.day. Conclusion:If it is planned to use a big amount of hypertonic liquid at the hydatic cyst surgery, intraoperative Na monitoring should be done. Intraoperative treatment should start when hypernatremia is developing and should be monitored in intensive care when necessary

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Hypernatremia , hydatic cyst surgery , hypertonic saline

Medical Journal Of Suleyman Demirel University

146