Dilutional hyponatremia caused by excess absorption of hypo-osmotic irrigation fluids is one of the severe complications during hysteroscopic surgery. Appropriate delivery system and distending media,proper distending pressure,and reducing destruction of uterine venous sinus may remarkably lower the morbidity. Meanwhile,early detection and timely treatment of moderate and severe hyponatremia to avoid the occurrence of secondary nervous system demyelination are particularly important during the surgery. This review summarizes the risk factors and the prevention and treatment strategies of dilutional hyponatremia during hysteroscopic surgery.