K. Geerinckx et al., ETHANOL EXHALATION AS A PREDICTOR OF DILUTION HYPONATREMIA DURING ENDOMETRIAL ABLATION, Gynaecological endoscopy, 7(4), 1998, pp. 193-201
This study investigated the effectiveness of ethanol as an early indic
ator of resorption during transcervical endometrium resection (TCRE).
Ethanol was added as a marker and exhaled alcohol concentrations were
measured with an Alcomed test. Ninety-three patients underwent endomet
rial ablation under general anaesthesia and exhaled ethanol levels and
blood sodium concentrations were monitored simultaneously every 3 min
utes. In 23% of the cases the Alcomed test was the first indicator of
absorption. Relevant changes in blood sodium concentrations appeared l
ater in 9% of the cases and gives a positive Alcomed test. The predict
ive exhaled ethanol value for preventing the transurethral prostate re
section (TUR) syndrome is 1.5 promille. A marked difference in fluid r
esorption during hysteroscopic myomectomy was observed (400-1000 mi du
ring TCRE and myomectomy vs. 100-300 mi TCRE only). Of 83 TCRE patient
s, 23 had a positive Alcomed test. Ten patients underwent a hysterosco
pic myomectomy. Sensitivity and specificity were determined for a decr
ease of more than 5 mmol l(-1) in blood sodium and for several ethanol
levels. The sensitivity was 100% for an ethanol level of at least 0.0
5 promille. The specificity was 90.9% and the positive predictive valu
e 41.7%. All patients with a decrease of more than 5 mmol l(-1) in blo
od sodium concentration were detected using a threshold of 0.05 promil
le exhaled ethanol and nine out of 10 patients with a blood sodium dec
rease of at least 5 mmol l(-1) also had an ethanol level of at least 0
.05 promille. Unfortunately a positive Alcomed test has a poor prognos
tic value.