Electrolytes free absorption/perfusion syndrome

R.A.S HEMAT, MB;BCh, FRCSI, DUL.

TURP syndrome was first described in 1947, as acute water intoxication causing hemolysis, jaundice and acute tubular necrosis.

Hyponatraemic shock induced by glycine absorption was first described in 1956 together with the introduction of 5% sodium chloride treatment for the syndrome.

TURP syndrome is precipitated by sodium-free fluid volumetric overload.

Signs and symptoms of TURP syndrome

Cardiopulmonary Hematological & renal Central nervous system
Respiratory distress Hemolysis Nausea/Vomiting
Cyanosis Acute renal failure Confusion
Hypertension Hyponatremia Twitches
widened QRS. or elevated ST. segment Hypo-osmolality Visual disturbance, or blindness
Dysrrhythmia Hyperglycinaemia Seizures
Bradycardia Hyperammonaemia Paralysis
Hypotension   Coma
Shock    

Factors affecting TURP syndrome

a- age of the patient, related to drop in serum protein; b- volumetric gain, c- hypo-osmolality; d- increase in serum glycine; e- drop in serum sodium; f- the type of intravenously infused fluids; g- the histology of the prostatic tissue; h- patient's weight.

Increase in serum glycine, can lead to osmolar gap if not measured and taken into consideration, which can detect a false impression of normo-osmolality. hyponatremia may occur but the serum osmolality may remain close to normal. Large amounts of glycine also stimulate the release of atrial natriuretic peptide in excess of that expected by the volume load, which further promotes natriuresis. The urinary excretion of sodium represents an absolute loss as the irrigant contains no electrolytes.

There is a higher incidence of CNS disturbances with glycine than with other irrigating solutions. Blurring of vision was first reported to be a complication of glycine absorption in 1956. Ammonia is normally converted to urea in the liver through the urea cycle. Patients with a nutritional deficiency of arginine and those with pre-existing liver disease are more likely to develop high ammonia concentrations.

Symptoms of hyponatraemia

Serum Na
E.C.G changes
CNS
120 mmol/L
Possible widening QRS.
Restlessness, confusion.
115 mmol/L
Widening QRS.

Elevated ST. segment.
Nausea.

Semicoma.
100 mmol/L
Ventricular tachycardia.

Fibrillation.
Seizures, coma.


April, 2001

Note: The information in this article has been excerpted from the following books: urotext-ebook simplifying urology, Principles of modern urology, by Dr. R.A.S HEMAT. Permission is granted to copy and redistribute this document electronically as long as it is unmodified. This article may not be sold in any medium, including electronic, CD-ROM, or database, or published in print, without the explicit, written permission of Dr. R. A. S. Hemat.

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