Reviewer ’s report  
 
Title: Life-threatening acute water intoxication in a  woman undergoing hysteroscopic 
myomectomy:  a case report and review of the literature  
 
Version: 1 Date: 21 Feb 2018  
 
Reviewer: Michael L. Moritz  
 
Reviewer's report:  
This is an extremely interesting case report. It is well written, concise and informative. The 
management of the patient was very good as was the outcome. I  only have one minor comment, 
it says that on presentation that she had a dilutional acidosis. I would take this out. The patient 
received a significant amount of sodium bicarbonate, so the acidosis was most likely much more 
severe at presentation and the acidosis may have been due to lactic acidosis.  It would also be 
worth adding in a maybe a little more detail in the discussion the dangers of combined hypoxia 
and hyponatremia. The hypoxia aggravates the cerebral edema from hyponatremia leading to 
non-cardiogenic pulmonary edema. This is mentioned in the discussion, but a little more 
emphasis on the dangers of this combination and how they are interrelated would improve the 
manuscript.  
 
Are the methods appropriate and well described?  
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Does the work include the necessary controls?  
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Are the conclusions drawn adequately supported by the data  shown?  
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additional statistical review?  
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assessment in your comments to the editors.  
 
 
 
Quality of written English  
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