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Isotonic hyponatremia following transurethral prostate resection
D M Rothenberg1, A S Berns, A D Ivankovich
1Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
Journal of Clinical Anesthesia
|January 1, 1990
Summary
Isotonic hyponatremia during transurethral prostate resection can cause neurologic changes. Glycine irrigant resorption, not cerebral edema, may be the cause, guiding appropriate treatment strategies.
Area of Science:
- Nephrology
- Neurology
- Urology
Background:
- Transurethral resection of the prostate (TURP) is a common procedure.
- Hyponatremia is a potential complication during TURP, with its management remaining controversial.
- Neurologic symptoms can arise during TURP, necessitating careful evaluation.
Observation:
- Two cases of isotonic hyponatremia during complicated TURP are presented.
- Patients experienced neurologic changes despite a rapid decrease in serum sodium concentration.
- Serum osmolality remained normal due to glycine irrigant resorption.
Findings:
- Glycine irrigant resorption can lead to isotonic hyponatremia during TURP.
- Cerebral edema may not be the sole cause of neurologic manifestations in these cases.
- The osmolar gap is a crucial indicator for appropriate therapeutic decisions.
Implications:
- Understanding isotonic hyponatremia in TURP is vital for accurate diagnosis.
- The osmolar gap can help avoid unnecessary hypertonic saline administration.
- A differential diagnosis for neurologic changes during TURP syndrome is essential for patient care.