Glycine Toxicity and Unexpected Intra-Operative Death

Byard, Roger W.; Harrison, R. J.; Wells, Robert L.; Gilbert, John D.

doi:10.1520/jfs15130j

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…Byard et al have published a case report of cardiac arrest in a 69 year old patient after cystolithopexy and transurethral resection of prostate using glycine irrigation, where very high levels of glycine were found in blood and urine, though glycine was not directly implicated [102]. Gbossou et al have published a case report of transient arrhythmia with very high levels of glycine after transcervical endometrial resection [103].…”

Section: Glycine Toxicitymentioning

confidence: 99%

The Role of Glycine in Hepatic Ischemia-Reperfusion Injury

Habib¹,

Hodgson²,

Davidson

2006

CPD

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Glycine is a non-essential amino acid which is cheap, easily available and relatively non-toxic. It is composed of a single carbon attached to an amino and a carboxyl group, with a molecular weight of 75. It is involved in the production of bile, nucleic acids, porphyrins and creatine phosphate. It is part of the normal human diet and is used clinically, as an irrigant solution in urological and gynaecological procedures. Glycine has broad spectrum anti-inflammatory, cytoprotective and immunomodulatory properties whose therapeutic role has largely been un-investigated. Since the demonstration of its cytoprotective effect on hypoxic cultured renal tubule cells, further research has established its mechanism of anti-inflammatory action, which depends on stimulation of glycine sensitive chloride channel receptors on the cell membrane. The mechanism of non-specific cytoprotective effect which is present even in chloride and calcium free media is not clear. However glycine is currently being used experimentally, in human liver transplant recipients and has been shown to be beneficial in animal models of ischemia-reperfusion injury (IRI) in liver and several other organs. This review addresses the properties of glycine, its mechanism of action and its role in modulating IRI with special reference to the liver, with the aim of stimulating translational research into the potential role of glycine as a pharmaceutical agent.

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Section: Glycine Toxicitymentioning

confidence: 99%

The Role of Glycine in Hepatic Ischemia-Reperfusion Injury

Habib¹,

Hodgson²,

Davidson

2006

CPD

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“…In animal studies increased ammonia levels led to elevated brain glutamate concentrations and increased NMDA receptor activation [13]. However, animal studies do not show convincing evidence of lethality associated with increasing levels of ammonia [2,8,14]. Despite the extremely high levels of ammonia in our patient, the levels quickly decreased over several days without any resultant neurological sequelae.…”

Section: Discussionmentioning

confidence: 68%

“…This can lead to a massive absorption, as in this case. Only one other report of bladder rupture and massive irrigation is reported [8].…”

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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“…Excessive administration of hypotonic parenteral fluids may critically lower sodium levels [20] and dilutional hyponatremia has been reported after surgical irrigation with glycine [21].…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia at autopsy: an analysis of etiologic mechanisms and their possible significance

Byramji

Cains²,

Gilbert³

et al. 2008

Forensic Sci Med Pathol

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While electrolyte measurements after death may be confounded by a number of variables, vitreous humor sodium tends to remain stable for some time, enabling correlation between ante- and postmortem levels. Review of natural and unnatural causes of reduced vitreous humor sodium levels at autopsy was undertaken to demonstrate the range of diseases that may result in this finding. Natural diseases affecting the vasopressin-renin-angiotensin axis may cause reduction in sodium levels with associated hypovolemia, euvolemia, and hypervolemia. Low sodium measurements may also occur with redistribution of water, and artefactually when there are underlying lipid and protein disorders. Unnatural causes of hyponatremia at autopsy include water intoxication from psychogenic polydipsia, environmental polydipsia, ingestion of dilute infant formulas, beer potomania, endurance exercise, fresh water immersion (including water births) and iatrogenic causes including drug and parenteral fluid administration, and surgical irrigation. A knowledge of the range of conditions that may result in lowered postmortem sodium levels will help to exclude or confirm certain diseases at autopsy. In addition, significant vitreous hyponatremia may be a useful finding to help clarify mechanisms of unnatural deaths.

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Glycine Toxicity and Unexpected Intra-Operative Death

Cited by 15 publications

References 10 publications

The Role of Glycine in Hepatic Ischemia-Reperfusion Injury

The Role of Glycine in Hepatic Ischemia-Reperfusion Injury

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

Hyponatremia at autopsy: an analysis of etiologic mechanisms and their possible significance

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