TURP syndrome: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) |
||
| Line 48: | Line 48: | ||
**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 | ||
*[[Seizure]] | *[[Seizure]] | ||
**[[Benzodiazepines]] +/- [[AEDs]] | **[[Benzodiazepines]] +/- [[AEDs]] | ||
Revision as of 17:31, 25 August 2019
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
- Hyponatremia, iso or mildly hypo-osmolar
- CBC
- Hemodilution
- +/- hemolysis
- Ammonia elevation
- Due to deamination of glycine and serine
- Serum osmolarity
- Osmolar gap elevated
- Due to glycine
- Osmolar gap elevated
- 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
- Seizure
- Benzodiazepines +/- AEDs
- Consider magnesium (NMDA receptor stabilization)
- Hypocalcemia- replete
- Monitor hemoglobin, transfuse pRBCs PRN
- May require dialysis in severe cases
Disposition
- ICU