From the Research
Yes, continuous bladder irrigation (CBI) can cause hyponatremia, particularly when non-electrolyte solutions like sterile water or glycine are used. This complication occurs through a process called "TURP syndrome" (named after transurethral resection of the prostate procedures), where irrigation fluid is absorbed through open venous sinuses or injured tissues in the bladder or prostate. When large volumes of hypotonic fluid enter the circulation, they dilute the serum sodium concentration, leading to hyponatremia 1. The risk increases with longer irrigation duration, higher irrigation pressures, and more extensive tissue resection. Symptoms of CBI-induced hyponatremia include confusion, headache, nausea, vomiting, visual disturbances, seizures, and in severe cases, coma.
Pathophysiology and Risk Factors
The pathophysiology of hyponatremia is complex and involves the regulation of water and electrolyte balance in the body 2. Hyponatremia can be classified into three main categories: hypovolemic, euvolemic, and hypervolemic, each with different underlying causes and treatment approaches. In the context of CBI, the use of hypotonic irrigation solutions can lead to water retention and dilutional hyponatremia.
Treatment and Prevention
To minimize the risk of CBI-induced hyponatremia, isotonic solutions like normal saline are preferred for irrigation when possible, and careful monitoring of fluid balance, electrolytes, and mental status should be performed during prolonged CBI 3. Treatment involves stopping the absorption of irrigation fluid, correcting electrolyte imbalances, and in severe cases, administering hypertonic saline under careful supervision. The use of vasopressin receptor antagonists, such as vaptans, may also be effective in treating hyponatremia, particularly in patients with euvolemic or hypervolemic hyponatremia 4.
Clinical Implications
The management of hyponatremia requires a systematic approach, taking into account the underlying cause, severity, and duration of the condition 5. Clinicians should be aware of the potential risks and benefits of different treatment options and carefully monitor patients for signs of hyponatremia, particularly during prolonged CBI. By prioritizing the use of isotonic irrigation solutions and careful monitoring, clinicians can minimize the risk of CBI-induced hyponatremia and improve patient outcomes.