A 72 years old patient with BPH underwent transurethral resection of prostate under spinal anaesthesia. After one hour, he developed vomiting and altered sensorium. The most probable cause is:
**Core Concept**
The patient in question has undergone a surgical procedure under spinal anesthesia, which may lead to a condition known as TURP syndrome. This syndrome is a collection of symptoms that arise due to the absorption of irrigation fluid used during transurethral resection of the prostate (TURP) procedure. The irrigation fluid, typically a glycine or sorbitol solution, can be absorbed into the bloodstream, causing a range of clinical manifestations.
**Why the Correct Answer is Right**
The correct answer is related to the pathophysiology of TURP syndrome. The absorption of the irrigation fluid leads to an increase in intravascular volume, which can cause a shift of fluid from the intravascular space to the interstitial space. This results in a decrease in serum sodium levels, leading to hyponatremia. The hyponatremia causes an osmotic shift of water from the brain to the extracellular space, resulting in cerebral edema. This is the most probable cause of the patient's vomiting and altered sensorium.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not relate to the pathophysiology of TURP syndrome. TURP syndrome is not caused by a local anesthetic toxicity.
**Option B:** This option is incorrect because it does not explain the patient's symptoms. The patient's vomiting and altered sensorium are not caused by a spinal cord injury.
**Option C:** This option is incorrect because it does not relate to the pathophysiology of TURP syndrome. The patient's symptoms are not caused by an allergic reaction to the surgical instrumentation.
**Clinical Pearl / High-Yield Fact**
TURP syndrome is a potentially life-threatening condition that requires prompt recognition and treatment. The key to diagnosis is the combination of symptoms such as nausea, vomiting, altered sensorium, and visual disturbances, along with laboratory findings of hyponatremia and hypotension.
**Correct Answer: C. TURP syndrome is a collection of symptoms that arise due to the absorption of irrigation fluid used during transurethral resection of the prostate (TURP) procedure.**