Turp syndrome (Ts) case reported
the turp syndrome, characterized by a defcit diselettrolitico and consequently the cardiovascular and autonomic nervous system. The rational resides in 'absorption by the body of high amount of volume of the endoscopic transmission fluid used (10 and 30 mlmin) for procedures, in this case, the turp to which must be added the toxicity, specific, the fluid used, which, subsequently, sometimes, makes it independent of the damage caused to the body by the absorbed volume .
The factors that influence such absorption are:
1) the transmission liquid 2) low pressure venosa3) prolonged endoscopic maneuver over 1 h 4) opening of numerous venous sinuses 5) perforation of the capsule thus facilitating the passage of the liquid in the cavity peritoneal and consequently its reabsorption
Materials and Methods
Patient data: Male of 65 years, luts 3v nocturia, in tp finasteride from 2 years , pa average of 130 / 85mm / hg (pa values generally normal no other therapy in progress), psa <4 ng / l, no familiar k prostate, dre negative in nodules', vol gland adenoma 60cc unweighted; hb12.5g / dl, creatinine 0.98
endoscopic resection duration 2h, 30 min after the turp: hyperthermia (up to 39.5 ° C), blood pressure down, sodium 125, means of transmission used physiological, energy used jayrus, grams resected undetected. Hb 11.0g / dl, creatinine 1.2
the symptoms can occur, even at 24 h from intervention, and is characterized by disparate epiphenomena, mostly triggered, after the reabsorption of the transmission medium, from hyponatremia: hypertension, hypotension, bradycardia, hypothermia, tachycardia, hyperthermia of reflection, scotoma and fotomi, hypoxia, nausea, severe vomiting, shortness of breath associated with pulmonary edema. The hypervolemia caused by excessive absorption of transmission fluid due to hypertension and bradycardia, between the other, fatigue of the left ventricle, which ease the transition in the fluid at the level of the third space, triggering pulmonary edema. The subsequent dilution of the osmolar concentration of sodium causes edema at the level of the central nervous system and subsequently hypovolemia
with all that sequela of symptoms mentioned before. For another variation of osmolarity induces hemolysis allowing it to settle of hemoglobin in the kidneys causing renal failure. Although, the use of some sources of energy and therefore of certain liquid transmission can be made more rare the phenomenon of resorption syndrome, it is, however, present. The tur syndrome in addition to the common pathophysiology of increase in circulating volume, recognizes a related toxicity liquid irrigation. Some examples are:
the distilled water provides the best optical vision, but causes, to a high extent, intravascular hemolysis due to the different serum osmolality. Therefore Next you have the precipitation of hemoglobin in the renal tubule causing acute renal failure.
• Glycine solution has an osmolarity of 200 mOsml / L, it is metabolized by the liver into ammonium and can lead to visual disturbances. High levels of ammonium, as known, may lead to neurological disorders.
• mannitol solution is the only irrigant isosmolar (275 mOsml / L). Not only it is metabolized and excreted by the kidneys, but for precisely the absorption of large amounts of mannitol move liquids in the vascular compartment and lead to rapid fluid overload, cardiac failure and pulmonary edema.
The treatment, of course varies depending on the symptoms and severity. It may be necessary to administer from atropine to adrenaline to correct a slow heartbeat or low blood pressure; anticonvulsant drugs, if they are Significantly greater neurological symptoms; blood transfusions, designed to rebalance both the hematocrit that the electrolyte balance; furosemide 40 mg only in the case in which there is the appearance of pulmonary edema, because of for if the drug induces sodium depletion .In addition in cases of severe hyponatremia (120 mmol / l) administering a hypertonic solution at 3% in order, however, to obtain a slow electrolytic rebalancing
Conclusion: the ts was treated with close monitoring of Pa and with infusion of hypertonic solution, facilitating the removal of the liquid from the third space but not facilitating sodium depletion (as is by administering furosemide) would take place. The patient gradually took in 6-h period normal values and returned asintomatic .The recognizing of this syndrome allows the implementation of the most appropriate measures to restore the patient's health
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