Volumetric Overload Shocks in the Patho-etiology of the Transurethral Resection Prostatectomy Syndrome and Acute Dilution Hyponatraemia
Salma A Ghanem1, Nisha Pindoria2, Khalid A Ghanem3 and Ahmed N Ghanem3
1) Royal London Hospital, London
2) North Middlesex University Hospital, London
3) Mansoura University Hospital, Egypt
Citation: Ghanem SA, Pindoria N, Ghanem KA, Ghanem AN (2020) Volumetric Overload Shocks in the Patho-etiology of the Transurethral Resection Prostatectomy Syndrome and Acute Dilution Hyponatraemia. SciTech Central Pharma 2020. Mauritius
Received: January 02, 2020 Accepted: January 07, 2020 Published: January 07, 2020
Abstract
Hypothesis: 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.
Objective: To report VOS and its successful treatment of hyper-tonic sodium therapy that is life saving. To report that Starling's law is wrong and the correct replacement is the hydrodynamic of the porous orifice (G) tube.
Methods: We conducted the following studies:
Prospective study on 100 consecutive TURP patients among whom 10 developed the TURP syndrome with acute dilution hyponatraemia (HN) and vascular shock.
A case series of 23 TURP syndrome cases.
A physics study on the hydrodynamic of the G tube.
Results: The TURP syndrome 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. In adults VOS1 is induced by the infusion of 3.5-5 litres of sodium-free fluids and is known as TURP syndrome or HN shock. VOS2 is induced by 12-14 litres of sodium-based fluids and is known as the adult respiratory distress syndrome. The most effective treatment for VOS1 and VOS2 is hypertonic sodium therapy (HST) of 5%NaCl or 8.4% Sodium Bicarbonate. The literature on TURS is reviewed and the underlying patho-etiology is discussed. Starling's law proved wrong and the correct replacement is the hydrodynamic of the G tube.
Conclusion: Volumetric overload causes shock of two types, VOS1 and VOS2. VOS 1 is characterized with acute dilution HN and is known as the TURP syndrome. Mistaking VOS1 for a recognized shock and treating it with vascular expansion is lethal while HST is life saving. Starling's law which dictates the rules on fluid therapy proved wrong and the correct replacement is the hydrodynamic of the G tube.
Key Words: Hyponatraemia; shock; the transurethral prostatectomy syndrome; the adult respiratory distress syndrome, Starling’s law, Capillary hydrodynamics
