TURP syndrome: Difference between revisions
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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== | ||
Latest revision as of 16:55, 29 September 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
- 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
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
- Metabolic panel
- 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
- Elevated due to deamination of glycine and serine
- Serum osmolarity
- Osmolar gap elevated due to glycine
- CXR - Signs of volume overload, pulmonary edema
- ECG - May have arrythmias in severe cases
Management
- 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