Turp syndrome



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#48459

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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