Symptomatic absorption of normal saline during transurethral resection of the prostate: a case report

Abstract

Background Transurethral resection of the prostate (TUR-P) could incidentally cause hyponatremia, known as TUR syndrome due to intravascular absorption of non-electrolytic irrigation fluid. Recently, normal saline has been used as an irrigation fluid in a new system named TURis (TUR in saline) to prevent TUR syndrome. However, rapid massive absorption of normal saline can also cause other systemic adverse events. Case presentation A 71-year-old man underwent TURis for benign prostatic hyperplasia under spinal anesthesia. The patient lost consciousness which led upper airway obstruction and hypoxia 30 min after the surgery began. Blood gas test indicated hyperchloremic metabolic acidosis. While vasoactive agents were ineffective, the administration of bicarbonate significantly improved the symptoms and restored blood pressure. Conclusion We experienced a case of hyperchloremic metabolic acidosis with decreased level of consciousness and hypotension during TURis. Administration of bicarbonate, but not phenylephrine, was effective for recovering blood pressure.

Hyperchloremic metabolic acidosis caused by a large influx of saline into the peritoneal and retroperitoneal cavities during transurethral resection

“…*Correspondence: marikom57@gmail.com et al [2] In addition, since the patient's symptoms may also have been due to increased intra-abdominal pressure, monitoring abdominal pressure with measured bladder pressure may have been useful for pathology discrimination in this situation.…”

“…Author details 1 Department of Anesthesiology, Ohara General Hospital, 6-1 Uwamachi, Fukushima 960-8611, Japan. 2 Department of Anesthesiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.…”

“…In this case, it is thought that HCA was caused by the large volume of saline in the peritoneal and retroperitoneal cavities. Acidosis may be associated with the development of restlessness and hypotension, as reported by Okuma et al [ 2 ] In addition, since the patient’s symptoms may also have been due to increased intra-abdominal pressure, monitoring abdominal pressure with measured bladder pressure may have been useful for pathology discrimination in this situation.…”

“…This patient had fluid accumulation in the peritoneal and retroperitoneal cavities after TURis, and blood gas analysis after reintubation showed HCA. A case of dilute HCA with the rapid transvascular absorption of perfusion saline during TURis has been reported [ 2 ]. In this case, it is thought that HCA was caused by the large volume of saline in the peritoneal and retroperitoneal cavities.…”

“…To the Editor, Transurethral resection in saline (TURis) systems tends to be adopted to avoid transurethral resection syndrome due to the systemic absorption of nonelectrolyte perfusate [1]. Nonetheless, hyperchloremic metabolic acidosis (HCA) due to rapid intravascular absorption of perfusate has also been reported with TURis [2]. However, there are no reports showing HCA due to the slow absorption of intraperitoneal saline.…”