Dilutional Hyponatremic Shock: Another Concept of the Transurethral Prostatic Resection Reaction

Volumetric overload shocks in the patho-aetiology of the Transurethral Resection of the Prostate (Turp) Syndrome and acute dilution hyponatraemia: The clinical evidence based on prospective clinical study of 100 consecutive Turp patients

“…It has been reported with other fluids such as Glucose, Mannitol and Sorbitol. It is known as TURP syndrome or HN shock [4] as HN is a marked serological marker for the condition [4,5]. VOS2 is induced by massive infusion of sodium-based fluids such as normal saline, Ringer, Hartmann, plasma and plasma substitutes and/or blood transfusions that may complicate the therapy of VOS1.…”

“…Osmotic solution such as Glycine, Mannitol and Cytal were then introduced but a complex clinical syndrome continued to occur [9]. Hyponatremic shock induced by Glycine absorption was described by Harrison et al (1956) 4 , who introduced 5% sodium chloride for treatment.…”

Validation of the ethanol breath test and on‐table weighing to measure irrigating fluid absorption during transurethral prostatectomy

“…Irrigating fluid absorption by the patient is a potentially serious complication of TURP, resulting in the 'TUR syndrome', with appreciable morbidity and mortality when significant volumes of fluid are absorbed [1,2]. It is also related to intraoperative cardiac stress [3,4] and may be associated with an increased long-term risk of myocardial infarction [5].…”

Letter to the Editor

“…anuria), due to the generalised cellular oedema, is an integral feature from the outset and is resistant to diuretics. Hence the condition may be misdiagnosed as a cerebral, myocardial or pulmonary infarction (Harrison et al, 1956). Post mortem examination may indeed reveal the generalised congestion, oedema and necrosis of such organs without a local vascular lesion to explain the findings.…”

“…Assessing the volume of the absorbed fluid by measuring the "missing" volume of the irrigating 1.5% glycine or noting the increase in the patient's body weight are other useful parameters. The patient can be treated by infusion of 200ml 5% sodium chloride increments, or the calculated total serum sodium deficit can be rapidly infused (Harrison et al, 1956), in order to correct the initial osmolality gap (Ghanem, 1987) calculated from the drop in serum sodium concentration (mmol/l) multiplied by the extracellular volume. When reassessing the patient's clinical condition, his blood pressure and CVP or PCWP, as well as his biochemical findings after each infusion, are useful.…”