Ammonia Toxicity Resulting from Glycine Absorption during a Transurethral Resection of the Prostate

Roesch, Ryland; Stoelting, Robert K.; Lingeman, James E.; Kahnoski, Richard J.; Backes, David J.; Gephardt, Stephen A.

doi:10.1097/00000542-198306000-00021

Cited by 78 publications

(15 citation statements)

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“…Dilutional hyponatremia is an initial conse¬ quence that may lead to electrocardiographic changes, increased blood pressure, nausea, encephalopathy, coma, and even death.2-3 Ammonia is an immediate metabolite of glycine, and hyperammonemia is also consid¬ ered a factor that may contribute to encephalopathy. [4][5] Visual disturbances have been observed over the years.6-7 These reports range from "dimming" or "darkening" of vision to "light percep¬ tion only" or even to "no light percep¬ tion" for several hours. Results of funduscopic examination have been reported to be normal.…”

mentioning

confidence: 99%

Transient Blindness Associated With Transurethral Resection of the Prostate

Creel¹,

Wang²,

Wong³

1987

Archives of Ophthalmology

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mentioning

confidence: 99%

Transient Blindness Associated With Transurethral Resection of the Prostate

Creel¹,

Wang²,

Wong³

1987

Archives of Ophthalmology

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“…Confusion, agitation, headache vomiting, muscle twitching, and seizures are commonly seen [4]. Hyponatremia and hyperammonemia are frequently reported [3,5,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperammonemia results from glycine metablolism [3,5,11]. Glycine, a non-essential amino acid, is metabolized to pyruvate by glycine synthase with the liberation of ammonium ions [12].…”

Section: Discussionmentioning

confidence: 99%

Glycine Induced Hyperammonemia After Bladder Rupture During Transurethral Resection of a Bladder Tumor

Dohrenwend

2013

J Med Cases

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Glycine is widely used as an irrigation fluid for transurethral procedures and rarely causes glycine toxicity. We report a case of profound hyperammonemia occurring from complications of a transurethral resection of a bladder tumor in a female. To our knowledge, no previously published report documents such a high serum ammonia level. A 76-year-old female with a past medical history included hypertension and hyperlipidemia underwent transurethral resection of the bladder tumor (TURBT). During her operative procedure the patient was found to have an invasive bladder tumor, which was resected using a resectoscope. During the procedure she received 24 liters of 1.5% glycine irrigation fluid. After the procedure the patient was found to have a distended lower abdomen. A retrograde cystogram confirmed that a rupture of the bladder occurred with extravasation of large amounts of fluid, thought to be glycine irrigation fluid. While in the recovery room the intubated patient was following simple commands. Her initial post-operative serum sodium level was 120 mmol/L. The patient was treated with normal saline continuous bladder saline irrigation and CT guided percutaneous drainage of the fluid collection. Twenty hours after the procedure the patient had an episode of tonic-clonic muscular activity. She was treated successfully with phenytoin and midazolam. The sodium decreased to a low of 109 mmol/L and the ammonia level peaked at 1,592 μmol/L. The patient underwent hemodialysis on post-operative day one. Three days after the procedure the patient was extubated and at her baseline mental status. Her ammonia levels returned to normal by day two. She was discharged from the hospital without neurological sequelae. Severe hyperammonemia is possible after massive pelvic and intraperitoneal glycine absorption. Such toxicity is survivable and can be associated with altered mental status and seizures.

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“…1 -3,5,6,9,10 Patients undergoing transurethral prostatectomy with glycine as the irrigation solution have been found, on rare occasions, to develop encephalopathy and visual disturbances caused by ammonia toxicity. 11,12 With the acceptance and widespread use of operative hysteroscopy, gynaecologists are now faced with similar complications.…”

Section: Discussionmentioning

confidence: 99%

Transient Blindness following Hysteroscopy

Karcı

Erkin

2003

J Int Med Res

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The potential adverse effects resulting from absorption of irrigation fluids during endoscopic procedures are well documented. Glycine, which is commonly used as an irrigation solution, has an inhibitory effect both on the central nervous system and on the retinal cells. We report the case of a woman who developed transient blindness following hysteroscopic myomectomy in which glycine was used as the irrigation solution.

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Ammonia Toxicity Resulting from Glycine Absorption during a Transurethral Resection of the Prostate

Cited by 78 publications

References 0 publications

Transient Blindness Associated With Transurethral Resection of the Prostate

Transient Blindness Associated With Transurethral Resection of the Prostate

Glycine Induced Hyperammonemia After Bladder Rupture During Transurethral Resection of a Bladder Tumor

Transient Blindness following Hysteroscopy

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