title: [Patient with pseudomyxoma peritonei in whom, hyperglycemia and hyponatremia were induced by massive intraperitoneal lavage with 5% glucose].
abstract: A 74-year-old woman was admitted to our hospital with weight loss and sense of abdominal distension. She was diagnosed to have pseudomyxoma peritonei based on careful examinations in the surgical department of our hospital. She therefore underwent elective surgery consisting of an ileocecal resection under general anesthesia. The induction of anesthesia was very smooth, but the patient's blood pressure became unstable during the operation. As a result, we inserted an arterial catheter into the radial artery, and the blood gas analysis showed severe hyperglycemia and hyponatremia. We determined that a massive amount of intraperitoneal lavage fluid with 5% glucose had been absorbed into the blood vessels. We administered regular insulin to manage the hyperglycemia and also mannitol and furosemide to treat the hyponatremia that had been caused by water intoxication. Thereafter, both the hyperglycemia and hyponatremia improved quickly, and the patient was extubated safely. We had little prior knowledge about pseudomyxoma peritonei, and therefore had not expected such an occurrence. Moreover we did not sufficiently provide the surgical team with all of the patient's information. In the future, we will maintain close cooperation with the surgical team and establish an appropriate anesthesia plan when we encounter patients presenting with pseudomyxoma peritonei.
authors.affiliation: Department of Anesthesia and Intensive Care, KKR Sapporo Medical Center Sapporo 062-0931.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Minami
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ito
authors.forename: Ryo
authors.initials: R
authors.lastname: Watabe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamane
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D002432:Cecum / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D005947:Glucose / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology*; D007010:Hyponatremia / Q000188:drug therapy / Q000209:etiology*; D007082:Ileum / Q000601:surgery; D007328:Insulin / Q000008:administration & dosage; D008353:Mannitol / Q000008:administration & dosage; D010533:Peritoneal Lavage / Q000009:adverse effects*; D011553:Pseudomyxoma Peritonei / Q000601:surgery*; D012996:Solutions
chemical_list: D007328:Insulin; D012996:Solutions; D008353:Mannitol; D005665:Furosemide; D005947:Glucose