Volumetric overload shocks in the patho-etiology of the transurethral resection prostatectomy syndrome and acute dilution hyponatraemia

Abstract

The transurethral prostatectomy syndrome (TURS) is defined as severe vascular hypotension reaction that complicates endoscopic surgery as a result of massive irrigating fluid absorption causing severe acute dilution hyponatraemia (HN) of <120 mmol/l. The vascular shock is usually mistaken for one of the recognized shocks and Volumetric Overload Shock type 1 (VOS1) is overlooked making Volumetric Overload Shock Type 2 (VOS2) unrecognizable. VOS1 is induced by the infusion of 3.5-5 liters of sodium-free fluids and is known as TURS or HN shock. VOS2 is induced by 12-14 liters of sodium-based fluids and is known as the adult respiratory distress syndrome. The most effective treatment for VOS1 and VOS2 is hypertonic sodium of 5% NaCl or 8.4% Sodium Bicarbonate. The literature is reviewed and the underlying patho-etiology is discussed. As Starling's law for the capillary-interstitial fluid transfer proved wrong an alternative mechanism was found by studying the hydrodynamics of the porous orifice (G) tube. Incorporating the G tube in a chamber (C), representing the interstitial space surrounding a capillary, demonstrated a rapid dynamic magnetic field-like fluid circulation between the C and G tube lumen. The G-C phenomenon is autonomous having both filtration and absorption forces making a true replacement for Starling's law.

The adult respiratory distress syndrome: Volumetric overload shocks in patho-etiology, correcting errors and misconceptions on fluid therapy, vascular and capillary physiology

“…This has subtly misled physicians into infusing big bolus VO for treating true or presumed hypovolaemia causing hypotension inducing ARDS or MOVD/F syndrome. The nihilistic approach used here is based on reminders of basic physics and physiology facts, plausible clinical observations [5], physics research revealing a novel hydrodynamic phenomenon [6], and clinical research [7,8] on VO complicating fluid therapy started 33 years ago [5] and has continued until today [6][7][8][9][10][11][12]. This report advances the hypothesis of VO over time as the causative insult of ARDS or MVOD/F.…”

“…Thus, any infused bolus VO that exceeds CVS capacity must leak out into the interstitial fluid (ISF) space within minutes. Excess fluid pools in the third potential space of pleura, peritoneum and gut and some enter the intracellular space while the kidneys are trying to execrate the surplus, if it does not fail [7][8][9]. One current widely received misconception is that any infused VO of plasma albumen or substitute must stay intravascular according to Starling's law on capillary-interstitial fluid equilibrium.…”

“…Patients who die go to the mortuary with it and those who recover must lose it before discharge from ICU and hospital. Internal flooding and edema of vital organs are obvious on the postmortem examination [7][8][9][10][11].…”

Ghanem’s New Discoveries in Medicine, Physiology and Urology and Nephrology?

“…The last 32 years of my career life were spent in investigating and reporting these articles. [1][2][3][4] The articles recognize two new types of socks and its treatment, proves that Starling's law for the capillary interstitial fluid transfer is wrong and provides an alternative mechanism; the hydrodynamics of a porous orifice (G) Tube. These discoveries resolve the puzzle of three clinical syndromes discovering its patho-etiology and new successful treatment; namely the Trans Urethral Resection of the Prostate (TURP) syndrome and acute dilution hyponatraemia, the Adult Respiratory Distress Syndrome (ARDS) and the Loin Pain Haematuria Syndrome (LPHS).…”

New Contribution to Medicine, Physiology and Urology

“…These newly reported articles present new discoveries in Medicine, Physiology and Urology [1][2][3][4]. The articles recognizes 2 new types of socks and its treatment, proves that Starling's law for the capillary interstitial fluid transfer is wrong and provides an alternative mechanism; the hydrodynamics of a porous orifice (G) Tube.…”