title: Changes in amino acids, ammonium, and coagulation factors after transcervical resection of the endometrium with a glycine solution used for uterine irrigation.
abstract: OBJECTIVE
  Transcervical resection of the endometrium with the use of 1.5% glycine for irrigation is associated with postoperative nausea in some patients. This could be because of hyponatremia or toxic effects of glycine and its metabolites. Moreover, 1.5% glycine is hypoosmolar, and hemolysis and fibrinolysis are possible. Changes in plasma factors related to these potential complications of transcervical resection of the endometrium were measured.
  
  
  METHODS
  In 101 patients undergoing transcervical resection of the endometrium sodium, ammonium, and coagulation factors were measured preoperatively and postoperatively at intervals. In the initial 30 patients glycine and 28 other amino acids were measured at the same intervals. The results were correlated with the patients' clinical status and operative parameters.
  
  
  RESULTS
  Glycine and nine other amino acids and ammonia showed increased postoperative plasma levels; these changes were correlated with the absorption of the irrigating glycine solution and the development of hyponatremia. Minor activation of fibrinolysis and hemolysis was also seen.
  
  
  CONCLUSIONS
  Nausea after transcervical resection of the endometrium with 1.5% glycine for irrigation may be partly explained by toxic effects of glycine and its secondary metabolites in addition to the effects of water intoxication and hyponatremia. Minor, clinically insignificant changes in the coagulation system may also occur. Studies on alternatives to glycine for creation of near-isotonic irrigating solutions are encouraged.
authors.affiliation: Department of Obstetrics and Gynecology, Central Hospital of Hedemark County, Hamar, Norway.
authors.forename: O
authors.initials: O
authors.lastname: Istre
authors.forename: E
authors.initials: E
authors.lastname: Jellum
authors.forename: K
authors.initials: K
authors.lastname: Skajaa
authors.forename: A
authors.initials: A
authors.lastname: Forman
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000097:blood*; D001779:Blood Coagulation Factors / Q000032:analysis*; D004717:Endometrium / Q000601:surgery*; D005260:Female; D005998:Glycine / Q000009:adverse effects*; D006801:Humans; D007038:Hypotonic Solutions / Q000009:adverse effects*; D008875:Middle Aged; D009325:Nausea / Q000209:etiology*; D000644:Quaternary Ammonium Compounds / Q000097:blood*; D007507:Therapeutic Irrigation / Q000009:adverse effects; D014869:Water Intoxication / Q000209:etiology
chemical_list: D000596:Amino Acids; D001779:Blood Coagulation Factors; D007038:Hypotonic Solutions; D000644:Quaternary Ammonium Compounds; D005998:Glycine