Hyponatremia as a complication after pituitary surgery is a symptomatic problem in 1 in 25 cases in our unit. In a prospective study, it was found more frequently, being observed in 3 out of 25 patients reported by Whitaker et al. (1), and 25% of 61 patients observed by Olson et al. (2) during a 2-wk period after surgery. Most patients are discharged before that time, so it is not practical to monitor them. Our practice is to monitor urine output and serum sodium during the hospital stay and to be wary if the patient complains of an unexplained sense of "lack of well-being" at the time of discharge. If unwell, the patient is not discharged until serum sodium is checked.
Left untreated, hyponatremia may cause seizures and, ultimately, coma. Treatment consists of fluid restriction to <1.5 L of free fluid daily until the sodium returns to normal. The symptoms of confusion and drowsiness may persist beyond the time that the biochemistry returns to normal. Second-line treatment involves the administration of hypertonic saline. This is seldom necessary and should only be given under endocrine supervision with extreme care because of the rare but dangerous complication of central pontine myelinolysis.
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