TURP Syndrome
9/11/10
OHOA pages 570-571
SP Notes
= fluid overload and hyponatraemia during TURP from large volumes of irrigation fluid being absorbed through venous sinuses.
- glycine 1.5% in H2O used (hyposomolar @ 220mmol/L) – non-conductive, non-haemolytic and has a neutral visual density
- patients absorb around 20mL/min
- average absorption = 1.5L
- absorption dependent on: pressure of infusion (keep bag <60cm), venous pressure
- symptoms from glycine being a inhibitory CNS neurotransmitter (not from increased brain water)
CLINICAL FEATURES
- restlessness
- headache
- tachypnoea
- hypoxia
- N+V
- visual disturbance (fixed pupils) -> resolves in a few hours
- confusion
- seizure
- coma
- APO
- cerebral oedema
Risk Factors
- surgical time > 1 hr
- height of bag > 70cm
- resected > 60g
- large blood loss
- perforation
- large amount of fluid used
- poorly controlled CHF
INVESTIGATIONS
- hyponatraemia
- iso-osmolar
- increased osmolar gap from absorbed glycine
- hyperammonaemia
- hyperglycinaemia
- hyperserinaemia (major metabolite of glycine)
- metabolic acidosis
MANAGEMENT
Resuscitate
- may require intubation for airway protection
- O2 +/- intubation and ventilation
- invasive monitoring
Electrolyte and Acid-base Abnormality
- severe iso-osmolar hyponatraemia
Specific Treatment
- frusemide 40mg IV
- phenytoin if convulsing
- hypertonic saline (only indicated if osmolality < 260 mOsmol/kg - raise Na+ by 10mmol/24hours)
- it is OK for there to be a rapid change in Na+ as long as there is not a sudden change in osmolality (this often happens with glycine metabolism)
Underlying Cause
- expedite surgery
- coagulate bleeding points
- stop IVF
- check Hb
Jeremy Fernando (2011)
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