Intravascular spill of hypertonic sodium chloride and the resultant serious and occasionally fatal consquences have been reported in association with induced midtrimester abortion. This report details 3 cases of intravascular spill of hyperosmolar urea. Although urea may pose less concern, because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. In addition, abnormal blood pigments may occasionally be noted in the urine. Treatment includes intravenous hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents.
PIP: 3 cases of intravascular spill of hyperosmolar urea during induced midtrimester abortion are reported. In each case 80 gm of urea had been infused. Although urea may pose less concern than hypertonic sodium chloride because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. Also, abnormal blood pigments may occasionally be noted in the urine. The 3 patients were 23, 20, and 24 years old, all para 0. The symptoms generally subsided after 30 minutes, and serum and urinary abnormalities returned to normal within 24 hours. Treatment included iv hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents for at least 24 hours. The 3 patients eventually underwent successful abortions, 1 with intraamniotic prostaglandin F2 alpha (PGF2a), and 1 with urea-PGF2a abortion, without further complications.