TURP syndrome — Hyponatremia + circulatory + neuro
Recognition during/after transurethral resection of prostate using hypotonic irrigation
Mnemonic device
Triad: dilutional hyponatremia + volume overload + ammonia/glycine toxicity
Mapping
Dilutional hyponatremia
Na <120 — confusion, seizures, coma; brain edema
Volume overload
Hypertension, bradycardia, pulmonary edema; CVP ↑
Glycine toxicity (1.5% glycine irrigant)
Visual disturbance, transient blindness, encephalopathy from ammonia metabolite
Other irrigants
Sterile water → hemolysis; sorbitol → hyperglycemia + osmotic diuresis
Risk
Resection time >60 min, prostate >45g, irrigation height >60 cm above patient
Clinical note: Early signs under regional: confusion, restlessness, visual changes (glycine). Treat: stop surgery, restrict fluids, hypertonic saline (3% NaCl) if Na <120 or symptomatic — correct slowly to avoid central pontine myelinolysis (target ↑ Na ≤8 mEq in 24h). Bipolar TURP + saline irrigant has largely eliminated this.