Delirium, mental confusion and nausea in patients who had undergone transurethral resection of prostate suggests: September 2009, September 2012
First, I need to recall what complications can arise from TURP. Transurethral resection is a common procedure for treating benign prostatic hyperplasia. During the procedure, a resectoscope is inserted through the urethra to remove prostate tissue. The irrigation fluid used during the surgery is crucial here.
Now, the classic complication associated with TURP is TURP syndrome. This happens when there's excessive absorption of the irrigation fluid, especially if it's a hypotonic solution like glycine. Glycine is often used because it's non-conductive and doesn't interfere with the electrical instruments. However, when large volumes are absorbed, it can lead to fluid overload and hyponatremia.
Hyponatremia is when sodium levels in the blood drop too low. Sodium is an essential electrolyte for nerve and muscle function. When sodium is low, cells in the body, particularly in the brain, start to swell. This can lead to neurological symptoms such as confusion, delirium, nausea, and in severe cases, seizures or coma. The symptoms mentioned in the question—delirium, confusion, and nausea—are all consistent with hyponatremia caused by TURP syndrome.
Let me check the options. The correct answer is likely TURP syndrome. Now, the other options might include things like hemorrhage, infection, or other complications. But the key here is the timing and the specific symptoms pointing towards a fluid and electrolyte imbalance.
For example, if the answer were hemorrhage, the patient would present with signs of shock, like hypotension, tachycardia, or blood loss. Infection would present with fever, pain, and maybe leukocytosis. But the question is about neurological symptoms, which points more towards TURP syndrome.
So, the core concept here is understanding the complications of TURP, particularly fluid absorption leading to hyponatremia. The clinical pearl is to remember that TURP syndrome is a classic cause of hyponatremia and neurological symptoms post-TURP, especially when hypotonic irrigation fluids are used. The key is recognizing the pathophysiology: rapid absorption of hypotonic solution leading to systemic dilution of sodium and subsequent cerebral edema.
**Core Concept**
The question tests knowledge of **TURP syndrome**, a complication of transurethral resection of the prostate (TURP) involving hyponatremia and neurological symptoms due to excessive absorption of hypotonic irrigation fluids (e.g., glycine). This leads to systemic fluid overload and sodium dilution.
**Why the Correct Answer is Right**
**TURP syndrome** occurs when hypotonic irrigation fluids are absorbed during surgery, causing **hyponatremia** and **cerebral edema**. Glycine, a non-conductive irrigation fluid, is rapidly absorbed in large volumes, diluting serum sodium and reducing osmolality. This disrupts central nervous system function, manifesting as **delirium, confusion, nausea**, and in severe cases, seizures or coma. The pathophysiology involves **osm