TURP syndrome

Revision as of 16:55, 29 September 2019 by ClaireLewis (talk | contribs) (Clinical Features)
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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

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
  • 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

Disposition

  • ICU

See Also

External Links

References