TURP syndrome.

    

     TURP (transurethral resection of the prostate) syndrome - it is a combination of fluid overload and hyponatremia, which occurs when large volumes of irrigation fluid are absorbed via open venous sinuses. The most commonly used irrigant is glycine 1.5% in water, which is hypotonic (osmolality 220 mosm/L). On average, patients absorb a total of 1–1.5 L, but absorption of up to 4–5 L can be possible.





TURP Syndrome is more likely to occur in patients with poorly controlled heart failure. Development of TURP syndrome depends on: fluide volume and pressure ( > 100cm H2O), duration of surgery ( > 1 hour), blood loss etc.

 Symptoms: 

  • restlessness
  • headache
  • tachypnea, respiratory distress
  • hypoxia
  • frank pulmonary edema
  • nausea, vomiting
  • visual disturbances
  • confusion, convulsions, and coma 
  • tachycardia and hypertension (or bradycardia and hypotension in case of rapid absorption).

The diagnosis can be confirmed by low serum sodium. An acute fall to < 120 mEq/L is always symptomatic.


 Management:
  • Terminate Surgery as soon as possible;
  • IV fluids stopped;
  • Check serum Na+ and Hb;
  • Give furosemide 40 mg IV;
  • If  Na+  < 120 mEq/L and is associated with neurological signs, consider giving hypertonic saline (NaCl 1.8–3%) to restore Na+ to around 125 mEq/L;
    • Remember!  Over-rapid correction of hyponatremia can result in permanent neurological damage (central pontine myelinolysis);
  • Give 1.2–2.0 ml/kg/hr of 3% saline until symptomatic improvement. This should produce a rise in serum Na+ of 1–2 mEq/L/hr;
  • Check the level of Na+ every hour.

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