TURP syndrome - Revision history

ClaireLewis: /* Clinical Features */

2019-09-29T16:55:26Z

Clinical Features

← Older revision		Revision as of 16:55, 29 September 2019
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	*Tachypnea, [[pulmonary edema]], [[hypoxia]], [[respiratory distress]]		*Tachypnea, [[pulmonary edema]], [[hypoxia]], [[respiratory distress]]
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*Hemolysis		*[[hemolytic anemia\|Hemolysis]]
	*[[AKI]]		*[[AKI]]
	*[[Bradycardia]] (reflex from fluid absorption), [[dysrhythmia]]		*[[Bradycardia]] (reflex from fluid absorption), [[dysrhythmia]]
	*[[Visual disturbances]] ([[visual loss]], fixed pupils)		*[[Visual disturbances]] ([[visual loss]], fixed pupils)
	*[[Confusion]], [[seizure]], [[coma]]		*[[Confusion]], [[seizure]], [[coma]]

	==Differential Diagnosis==		==Differential Diagnosis==

Mholtz at 19:04, 25 August 2019

2019-08-25T19:04:25Z

← Older revision		Revision as of 19:04, 25 August 2019
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	*Complication seen after transurethral resection of prostate when large volumes of glycine-based irrigation fluids absorbed through venous sinuses, causing volume overload and hyponatremia, as well as CNS effects due to glycine		*Complication seen after transurethral resection of prostate when large volumes of glycine-based irrigation fluids absorbed through venous sinuses, causing volume overload and hyponatremia, as well as CNS effects due to glycine
	**Glycine inhibits GABA receptors and potentiates NMDA receptors		**Glycine inhibits GABA receptors and potentiates NMDA receptors
	*~~Rarer~~ currently due to changes in irrigation fluid composition		*More rare currently due to changes in irrigation fluid composition
	*Can also be seen after other procedures that require large volume irrigation, such as hysteroscopy		*Can also be seen after other procedures that require large volume irrigation, such as hysteroscopy

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	==Evaluation==		==Evaluation==
	*~~CMP~~		*Metabolic panel
	**[[Hyponatremia]], iso or mildly hypo-osmolar		**[[Hyponatremia]], iso- or mildly hypo-osmolar (due to dilutional effect of large volume fluid as well as natriuresis)
	***Due to dilutional effect of large volume fluid as well as natriuresis		**[[Hypocalcemia]] (due to precipitation of calcium with metabolites of glycine as oxalate crystals)
	**[[Hypocalcemia]]
	***Due to precipitation of calcium with metabolites of glycine as oxalate crystals
	*CBC		*CBC
	**Hemodilution		**Hemodilution
	**+/- [[hemolytic anemia\|hemolysis]]		**+/- [[hemolytic anemia\|hemolysis]]
	*Ammonia ~~elevation~~		*Ammonia
	**~~Due~~ to deamination of glycine and serine		**Elevated due to deamination of glycine and serine
	*Serum osmolarity		*Serum osmolarity
	**Osmolar gap elevated		**Osmolar gap elevated due to glycine
	***Due to glycine		*[[CXR]] - Signs of volume overload, pulmonary edema
	*[[CXR]]		*[[ECG]] - May have arrythmias in severe cases
	**Signs of volume overload, pulmonary edema
	*[[ECG]]
	**+/- ~~arrhythmias if~~ severe

	==Management==		==Management==
	*~~Address~~ ABCs- address [[pulmonary edema]], [[dysrhythmias]]		*ABCs - address [[pulmonary edema]], [[dysrhythmias]]
	*Volume overload: [[furosemide]] IV		*Volume overload: [[furosemide]] IV
	*[[Hyponatremia]]:		*[[Hyponatremia]]:
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	==External Links==		==External Links==
			*[https://litfl.com/turp-syndrome/ Life in the Fast Lane - TURP Syndrome]

	==References==		==References==
	~~https://litfl.com/turp-syndrome/~~
	<references/>		<references/>

	[[Category:Urology]] [[Category:Surgery]] [[Category:FEN]]		[[Category:Urology]]
			[[Category:Surgery]]
			[[Category:FEN]]

ClaireLewis: /* Management */

2019-08-25T17:31:39Z

Management

← Older revision		Revision as of 17:31, 25 August 2019
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	**Goal to raise Na+ by 10-12mmol over 24h		**Goal to raise Na+ by 10-12mmol over 24h
	**Rapid increase in Na+ not concerning (as may occur with glycine metabolism) UNLESS there is sudden change in osmolality		**Rapid increase in Na+ not concerning (as may occur with glycine metabolism) UNLESS there is sudden change in osmolality
	~~fluid overload: frusemide 40mg IV~~
	*[[Seizure]]		*[[Seizure]]
	**[[Benzodiazepines]] +/- [[AEDs]]		**[[Benzodiazepines]] +/- [[AEDs]]

ClaireLewis: /* Evaluation */

2019-08-25T17:31:18Z

Evaluation

← Older revision		Revision as of 17:31, 25 August 2019
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	*CBC		*CBC
	**Hemodilution		**Hemodilution
	**+/- hemolysis		**+/- [[hemolytic anemia\|hemolysis]]
	*Ammonia elevation		*Ammonia elevation
	**Due to deamination of glycine and serine		**Due to deamination of glycine and serine
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	*[[ECG]]		*[[ECG]]
	**+/- arrhythmias if severe		**+/- arrhythmias if severe


	==Management==		==Management==

ClaireLewis: Created page with "==Background== *Complication seen after transurethral resection of prostate when large volumes of glycine-based irrigation fluids absorbed through venous sinuses, causing volu..."

2019-08-25T17:30:40Z

Created page with "==Background== *Complication seen after transurethral resection of prostate when large volumes of glycine-based irrigation fluids absorbed through venous sinuses, causing volu..."

New page

==Background==
*Complication seen after transurethral resection of prostate when large volumes of glycine-based irrigation fluids absorbed through venous sinuses, causing volume overload and hyponatremia, as well as CNS effects due to glycine
**Glycine inhibits GABA receptors and potentiates NMDA receptors
*Rarer currently due to changes in irrigation fluid composition
*Can also be seen after other procedures that require large volume irrigation, such as hysteroscopy

==Clinical Features==
*Onset 15min-24h post-op
*May range in severity from mild to life-threatening
*Typically lasts hours but neuro symptoms may last longer if complicated
*[[Headache]], restlessness
*Burning sensation in face/hands,
*Tachypnea, [[pulmonary edema]], [[hypoxia]], [[respiratory distress]]
*[[Nausea/vomiting]]
*Hemolysis
*[[AKI]]
*[[Bradycardia]] (reflex from fluid absorption), [[dysrhythmia]]
*[[Visual disturbances]] ([[visual loss]], fixed pupils)
*[[Confusion]], [[seizure]], [[coma]]

==Differential Diagnosis==

==Evaluation==
*CMP
**[[Hyponatremia]], iso or mildly hypo-osmolar
***Due to dilutional effect of large volume fluid as well as natriuresis
**[[Hypocalcemia]]
***Due to precipitation of calcium with metabolites of glycine as oxalate crystals
*CBC
**Hemodilution
**+/- hemolysis
*Ammonia elevation
**Due to deamination of glycine and serine
*Serum osmolarity
**Osmolar gap elevated
***Due to glycine
*[[CXR]]
**Signs of volume overload, pulmonary edema
*[[ECG]]
**+/- arrhythmias if severe

==Management==
*Address ABCs- address [[pulmonary edema]], [[dysrhythmias]]
*Volume overload: [[furosemide]] IV
*[[Hyponatremia]]:
**[[Hypertonic saline]] only if severe neuro manifestations (e.g. seizures) AND serum osmolality <260
**Goal to raise Na+ by 10-12mmol over 24h
**Rapid increase in Na+ not concerning (as may occur with glycine metabolism) UNLESS there is sudden change in osmolality
fluid overload: frusemide 40mg IV
*[[Seizure]]
**[[Benzodiazepines]] +/- [[AEDs]]
**Consider [[magnesium]] (NMDA receptor stabilization)
*[[Hypocalcemia]]- replete
*Monitor hemoglobin, transfuse [[pRBCs]] PRN
*May require [[dialysis]] in severe cases

==Disposition==
*ICU

==See Also==
*[[Hyponatremia]]

==External Links==

==References==
https://litfl.com/turp-syndrome/
<references/>

[[Category:Urology]] [[Category:Surgery]] [[Category:FEN]]