The physiologic basis of the TUR syndrome.
To better assess the role of hyperammonemia versus hypoosmolarity versus hyponatremia in the TUR syndrome, we developed a rat model. Sprague-Dawley female rats received an intraperitoneal injection (250 cc/kg body weight) of either 1.5% glycine, 2.0% glycine, 2.0% glycine plus 1.5% mannitol, 3.0% mannitol, 5.0% mannitol, or 2.0% glycine plus 0.25% saline. Arterial blood samples were obtained prior to injection, at 2, 8, 16, and 24 hr and analyzed for osmolarity, sodium, and ammonia. Those animals receiving 2.0% glycine, 2.0% glycine plus 1.5% mannitol, and 5.0% mannitol all died within 24 hr with lethargy, convulsions, and coma. Hyponatremia developed in all animals; death, however, occurred only when the sodium concentration declined to 90-95 meq/dl. Mannitol maintained serum osmolarity but did not prevent coma and death. Including 0.25% saline in the initial injection, or an iv injection of 5.0% saline delayed 8 hr achieved 100% survival. Ammonia concentrations increased 15-fold by 8 hr in groups receiving 2.0% glycine; it rapidly decreased to near normal by 24 hr. Decreasing the rise in ammonia by 50% with iv arginine had no effect on survival. Our results suggest that hyponatremia rather than hyperammonemia or hypoosmolarity accounts for the major morbidity and mortality secondary to the TUR syndrome.
Bernstein
G T
GT
Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
Loughlin
K R
KR
Gittes
R F
RF
D000641:Ammonia / Q000097:blood; D000818:Animals; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000209:etiology*; D002493:Central Nervous System Diseases / Q000097:blood / Q000150:complications / Q000209:etiology*; D005260:Female; D005998:Glycine / Q000097:blood; D007010:Hyponatremia / Q000150:complications; D008297:Male; D009994:Osmolar Concentration; D011183:Postoperative Complications; D011467:Prostate / Q000601:surgery*; D051381:Rats; D011919:Rats, Inbred Strains; D013577:Syndrome; D014521:Urethra / Q000601:surgery*
D000641:Ammonia; D005998:Glycine