Acute symptomatic hyponatremia following elective rhinoplasty: A case report

We present the first reported case of symptomatic hyponatremia after elective rhinoplasty. A 42-year old female underwent cosmetic rhinoplasty without complication and was discharged home after an uneventful recovery from general anesthesia. Just prior to midnight on the day of surgery, she reported nausea, which was treated with supportive care. Four hours later, she developed emesis, altered mental status, and seizure-like activity prompting medical transport to the emergency department. Upon arrival, she was hypotensive (BP 78/54), tachycardic (HR 112 bpm), hyponatremic (116 mmol/L), hypoosmotic (239 mOsm/kg), and had decreased consciousness (GCS = 10). She was admitted to the intensive care unit and had a central line placed for hypertonic saline infusion. Urinalysis was suggestive of SIADH (UrNa 111 mmol/L, UrOsm 546 mOsm/kg) and Nephrology was consulted. Her serum sodium was corrected over three days and her mental status improved. Surgeons should maintain a low threshold for further evaluation in patients who deviate from the expected postoperative recovery pathway. This report demonstrates that normal postoperative symptoms may mask underlying physiological abnormalities that can progress to acute life-threatening illness and underscores the importance of direct patient observation in the immediate postoperative period.