Icahn School of Medicine at Mount Sinai - NYC Health + Hospitals/Elmhurst Elmhurst, NY
Introduction: The water immersion endoscopic method is a safe and often used endoscopic technique. We report a unique case of electrolyte abnormalities in a single balloon enteroscopy secondary to this procedure
Case Description/Methods: A 70-year-old female with HTN and hypothyroidism presented for single balloon enteroscopy for removal of a retained capsule. The capsule was initially performed for the of work up of melena and iron deficiency anemia after a negative upper endoscopy and colonoscopy. Physical exam and labs prior to the procedure were normal, including a sodium level of 139. The patient underwent the planned enteroscopy with water emersion with an estimated amount of 4 L of water being used. Shortly after completion of the procedure, the patient was noted to be delirious and have an altered mental status. The patient became aphasic, began clenching her fists, and was shaking. A sodium level post-procedure was obtained and was 113. A head CT scan was performed and no central involvement was noted. The patient was managed with 3% hypertonic saline and her symptoms resolved. Over the next 2 days patient’s sodium level normalized and the patient was discharged from the hospital.
Discussion:
This is the first reported case of hyponatremia secondary to water immersion endoscopy. While there is an abundance of reports describing hyponatremia in urologic and gynecologic procedures those procedures generally use glycine and mannitol as their irrigate. With regards to GI procedures, hyponatremia secondary to polyethylene glycol-electrolyte preparation has infrequently been reported. Free water irrigation/immersion is generally regarded as safe during gastroenterological procedures. Our case, brings awareness to the possibility of symptomatic hyponatremia following prolonged enteroscopy with the use of large volume water irrigation/immersion. Absorption of ingested water and most solutes occur in the proximal small intestine.
If large amount of fluids are necessary then normal saline can be utilized instead of water. Limiting water to 1.5 liters and suctioning excess water can help minimize these complications. Clinicians should be aware of this serious complication when performing these procedures.
