Changes in serum sodium concentration after transurethral procedures

Abstract

The aim of this study is to evaluate the changes in serum sodium concentration and the degree of correlation with factors such as the amount of intravenous fluid intake, the kind and the amount of irrigating fluids and the duration of the procedure. In this framework, 98 male patients who underwent transurethral procedure were studied and the correlation between the magnitude of hyponatraemia and the above-mentioned parameters was evaluated. All procedures were performed under spinal anesthesia and a solution of either manitol-sorbitol or sterilized water was used as irrigation fluid. Serum sodium concentration was measured before and after the procedure, while the kind and amount of the irrigating fluids, the amount of fluid intake and the duration of the procedure were also recorded. The patients were divided into three groups according to the duration of the procedure (i) <30 min, (ii) 30-60 min, and (iii) >60 min. Significant reduction in serum sodium concentration was found postoperatively (P < 0.001) and this was more profound in procedures longer than 1 h. This reduction was strongly correlated only with the duration of the transurethral procedure (P < 0.01). In conclusion, in transurethral procedures the reduction in serum sodium is postoperatively related to the duration of the procedure, while the intravenous and irrigating fluids to play no role on it.

Frecuencia de hiponatremia posoperatoria en pacientes sometidos a cirugía mayor en un centro de tercer nivel

“…Si bien el objetivo de este trabajo no fue conocer las causas del desarrollo de hiponatremia, la mayor frecuencia de hiponatremia en pacientes sometidos a cirugía urológica podría deberse al gran volumen de soluciones utilizadas para irrigar el campo quirúrgico en procedimientos como la RTUP o la resección transuretral de tumores de vejiga [28]. Por otro lado, en la génesis de la hiponatremia posquirúrgica se ha involucrado principalmente la infusión de soluciones hipotónicas en presencia de niveles elevados de hormona antidiurética [14,16,29,30], condiciones que podrían explicar la baja concentración de sodio en los pacientes del servicio de cirugía gastrointestinal, ya que más del 80 % de los pacientes de este servicio fueron tratados con soluciones hipotónicas y la mayoría presentaba uno o varios estímulos no osmóticos para la liberación de vasopresina, incluyendo dolor posoperatorio, nausea, estrés y polifarmacia [31].…”

In vivosodium concentration continuously monitored with fluorescent sensors

“…Experimental studies on hyponatremia and electrolyte imbalances have been very limited due to the lack of technology to continuously monitor sodium concentration. 15,16 Blood gas analyzers require, at a minimum, 40 ml of blood to perform a test. 40 This requires blood draws every time a measurement is performed.…”

“…15 In a recent study following sodium levels during TURP, hyponatremia was solely dependent on procedure length. 16 The study, however, was limited to two sodium concentration measurements and therefore onset of hyponatremia could not be determined. If continuous sodium monitoring were available the surgery could continue until a dangerous drop in concentration occurred.…”