| Sodium Physiology
| TURP Hyponatraemia syndrome
| Diabetes Insipidus
|Benign Prostatic Hyperplasia
Transurethral resection (TUR) syndrome is an iatrogenic
form of water intoxication, a combination of fluid overload
- A cause of acute hyponatraemia post TURP
- A medical emergency in a surgical patient
- Transurethral resection of the prostate consists of removal of prostatic tissue by means of electrocautery.
- The electro-cautery wire loop is positioned in the patient's urethra through a special sheath. The surgical field is visualized through a scope.
- Irrigation solution is used to distend the bladder, clear the surgical site, and remove blood and resected tissue.
- Normal saline cannot be used as irrigation solution because the dissemination of the electric current would be dangerous to both, surgeon and patient.
- Distilled water provides excellent optical view but causes hyponatraemia, intravascular haemolysis, and hyperkalaemia
- Subsequent haemoglobin precipitation in the renal tubules causes acute renal failure.
- In practice glycine is used which has a osmolarity of 200 mOsml/L Normal is 275-285. The result is a sudden water overload resulting in dilutional hyponatraemia
- Transient prickling and burning sensations in the face and the neck together with
lethargy and apprehension
- Patient may become restless and complain of a headache
- Confusion, Seizure, Coma, Bradycardia and arterial hypotension
- These come on during or in the hours post surgery
- Progressive coma and seizures
- U&E shows low sodium = 120 mmol/L
- Plasma osmolality reduced
- There is a worry of Central pontine myelinolysis which is associated with demyelination of the brainstem when more chronic hyponatraemia is rapidly reversed
- Stop the surgery if perioperative
- Others might give 300-500 mls 3% N-saline with Furosemide to cause diuresis often about 1 L of 3% in 24 hrs
- Correct the hyponatremia slowly but sufficiently to avoid hyponatraemic symptoms