Atypical presentation of acute hyponatremia in transurethral resection of prostate surgery: A case report

Abstract

We report a case of unusual presentation of transurethral resection of prostate (TURP) syndrome. A 58-year-old male patient with grade III benign hypertrophic hyperplasia was scheduled for TURP under spinal anesthesia. At 120 min of surgery, the patient presented with atypical symptoms of tightness in the chest with difficulty in breathing. The electrolyte analysis revealed an acute hyponatremia (serum Na+ 95 mEq/l). Patient was successfully treated with rapid infusion of 3% hypertonic saline along with furosemide.

Prophylaxis versus treatment against transurethral resection of prostate syndrome: The role of hypertonic saline

“…TURP is regarded as the most common surgical procedure performed on male patients aging more than 60 years. [ 3 ] Nonconductive irrigation fluid is necessary for the operating field during the use of a monopolar electric resectoscope. [ 2 ] The excessive absorption of this hypotonic, electrolyte-free, distension solution through the opened venous sinuses of the prostatic plexus can cause fluid overload and dilutional hyponatremia.…”

“…[ 2 ] The excessive absorption of this hypotonic, electrolyte-free, distension solution through the opened venous sinuses of the prostatic plexus can cause fluid overload and dilutional hyponatremia. [ 3 7 ]…”

“…This could be due to the absorption of hypotonic irrigating fluid into the lungs, resulting in bilateral basal crepitations and SpO 2 drop. [ 3 ] Under general anesthesia, the early signs are related to the cardiorespiratory system and include a decrease in SpO 2 and ECG changes. [ 21 ]…”

“…[ 2 ] This syndrome consists of a spectrum ranging from asymptomatic hyponatremia to electrocardiogram (ECG) changes, nausea, vomiting, headache, dizziness, convulsions, coma, and death. [ 3 ] Therefore, spinal anesthesia is often recommended during TURP so that early neurological deterioration signs can be detected. [ 2 ]…”