Delirium, mental confusion and nausea in patients who had undergone transurethral resection of prostate suggests: September 2009, September 2012
Ans. D: Water retention Water intoxication occurs in TURP. Significant amounts of fluid may be absorbed during a TURP, especially if venous sinuses are opened early or when the operation is prolonged. On average during a TURP, approximately 20 mL of fluid per minute is absorbed, or approximately 1000-1200 mL in the first hour of resecting time. One third of this fluid is absorbed directly into the venous system. This may lead to dilutional hyponatremia (TUR syndrome), which causes mental confusion, nausea, vomiting, visual disturbances, hemolysis, hemoglobin nephropathy, coma, and shock. Symptoms of TUR syndrome generally do not occur until the serum sodium level has decreased to 125 mEq or less. There will be clonus and positive Babinski responses. Papilloedema, with dilated, sluggishly reacting pupils can occur. The EEG will show low voltage, bilaterally. Hemodynamically, this is characterized initially by increased central venous pressures, hypeension, bradycardia, and other signs of early vascular overload, including restlessness, tachypnea, and sometimes dusky skin changes of the conjunctiva, mucous membranes, or fingernails. The incidence of this condition has been reduced since the introduction of isotonic glycine for performing the resections and the use of isotonic saline for postoperative irrigations.
Hypernatremia
Sepsis
Hepatic coma
Water retention