Dilutional hyponatremia in a community hospital setting: case report

Transurethral resection of the prostate (TURP) syndrome describes the symptomatic absorption of hypotonic irrigation fluid used during a TURP procedure, the culmination of which could possibly lead to death. During the procedure, electrocautery is used to excise the urethral-occluding prostate tissue while an irrigation solution removes incisional debris and facilitates a clear surgical view. Through direct communication with the prostatic circulatory system, rapid absorption of irrigation solution can occur. Compared with bipolar and laser resectoscopes which allow the use of isotonic irrigation solution, monopolar resectoscopes require the use of an electrolyte-free irrigation solution to prevent electricity scatter. This presents a unique patient safety challenge for the smaller institutions around the world which continue to implement this technology. This article discusses a case report of a patient with TURP syndrome admitted to our surgical intensive care unit.