Irrigation TUR syndrome

Question 1

why is glycine used

why water not used

Answer 1

non ionic fluid that does not conduct electricity
so cannot use saline
large parts world use water
risk of intravascular haemolysis when using water

Question 2

definition TUR syndrome

Answer 2

dilutional hyponatraemia that occurs when fluid is aborbed through venous channels commonly during turp
characterised by serum sodium less than 125 and two or more associated clinical symptoms

Question 3

symptoms associated with dilutional hyponatraemia 9

Answer 3

nausea
vomiting
confusion
visual disturbance
bradycardia
hypotension
chest pain
anxiety
parasthesia

Question 4

how hypertension leads to hypotension

Answer 4

initial intravascular volume expansion by up to 20ml / min can cause hypertension

later hyponatraemia, hypertension lead fluid shift from IV space along osmmotic and hydrostatic pressure gradients resulting in hypotension and pul oedema
factors aggravate hypotension direct toxic effect glycine on myocardium

Question 5

why does hyponatraemia occur

Answer 5

acute hyponatraemia occurs due to ab large volumes irrigated
hypo osmolality main cause neurological signs as BBB is impermeable to sodium but freely permeable to water
cerebral oedema leads to bradycardia and hypertenson via cushing relfex
diuretics may exacerbate hyponatraemia

Question 6

why does hyper ammonaemia occur

Answer 6

metabolism glycine by kidneys and liver

oxidative deamination to glyoxylic acid and ammonia

Question 7

mechanism glycine neurotransmitter

Answer 7

action may involve NMDA an excitatory NT
since NMDA receptor activity is potentiated by glycine causing visual changes, enceph, seizure
glycine itself as NT in retina

Question 8

treatment seizures

Answer 8

usually resistant to benzo and anticonsulvant therapy

magnesium therapy can have inhibitory effect on NMDA receptor