Related Subjects:
|Sodium Physiology
|Hyponatraemia
|TURP Hyponatraemia syndrome
|Hypernatraemia
|Diabetes Insipidus
|Benign Prostatic Hyperplasia
|Prostate Cancer
Transurethral resection (TUR) syndrome is an iatrogenic
form of water intoxication, a combination of fluid overload
and hyponatremia due to absorption of Large volumes of hypotonic irrigation fluid (e.g., glycine, sorbitol, mannitol) are used during TURP to maintain a clear surgical field.
About
- A cause of acute hyponatraemia post TURP
- A medical emergency in a surgical patient
Aetiology
- Transurethral resection of the prostate involves removal of prostatic tissue by means of electrocautery.
- Irrigation solution is used to distend the bladder, clear the surgical site, and remove blood and resected tissue.
- Normal saline cannot be used as it conducts electric current and would be dangerous to both, surgeon and patient.
- Distilled water does not conduct 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
Prevention
- Use isotonic irrigation fluids instead of hypotonic solutions whenever possible.
- Limit the duration of the TURP procedure to reduce the risk of significant fluid absorption.
- Monitor fluid balance and electrolyte levels closely during and after the procedure.
- Train surgical and anaesthesia teams to recognize and manage early signs of TURP syndrome.
Clinical
- 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
Investigations
- U&E shows low sodium = 120 mmol/L
- Plasma osmolality reduced
Management
- ABC. Oxygen. Central pontine myelinolysis is a potential complication.
- Stop the fluids and the surgery if perioperative. Monitor sodium.
- Consider 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
- Intensive care unit (ICU) admission for severe cases.
Review