What happens if D5 (Dextrose 5%) is given intravenously in the immediate postoperative period of a Transurethral Resection of the Prostate (TURP) procedure?

Administration of D5 in the Immediate Post-Operative Period of TURP

Administering D5 (Dextrose 5%) intravenously in the immediate postoperative period of TURP can worsen hyponatremia and potentially precipitate TURP syndrome, which can lead to serious complications including pulmonary edema, cardiovascular collapse, and even death.

Understanding TURP Syndrome and Fluid Management

• TURP syndrome occurs when excessive amounts of hypotonic irrigation fluid are absorbed into circulation during the procedure, leading to hyponatremia, decreased serum osmolality, and potential complications including heart failure, cerebral edema, pulmonary edema, and cardiovascular collapse 1
• The incidence of TURP syndrome ranges from 0.78% to 1.4%, making it a relatively uncommon but serious complication 1
• Severe hyponatremia (Na+ levels as low as 90-112 mmol/L) can develop during TURP procedures, requiring immediate intervention 2

Why D5 Should Be Avoided Post-TURP

• D5 is a hypotonic solution that can worsen existing hyponatremia that may have developed during the TURP procedure 3
• Patients who undergo TURP are at risk for fluid overload due to absorption of irrigation fluid during the procedure, and administering additional hypotonic fluids can exacerbate this condition 3
• Severe hyponatremia from TURP can lead to neurological symptoms including confusion, seizures, coma, and even death 4

Recommended Fluid Management Post-TURP

• Balanced crystalloid solutions are recommended as maintenance fluids in the immediate post-operative period of TURP rather than D5 or normal saline 3
• Careful monitoring of serum sodium levels is essential in the post-operative period, especially if hyponatremia is suspected 3
• For patients who develop hyponatremia, treatment with hypertonic saline (3% NaCl) may be necessary to correct sodium levels gradually 1

Special Considerations

• Bipolar TURP has a more favorable safety profile than monopolar TURP but still requires careful fluid management in the post-operative period 3
• Patients with pre-existing cardiac or renal conditions are at higher risk for complications related to fluid management and require even more careful monitoring 3
• The risk of TURP syndrome is related to the amount of irrigation fluid absorbed, which correlates with prostate size, resection time, and surgical technique 5

Monitoring and Management Protocol

• Regular monitoring of vital signs, urine output, and fluid balance is essential during the immediate post-operative period 3
• Serum sodium levels should be checked if symptoms of hyponatremia develop (confusion, nausea, headache, seizures) 2
• If TURP syndrome is suspected, immediate treatment should include:
  • Discontinuation of any hypotonic fluids (including D5) 1
  • Administration of diuretics if fluid overload is present 1
  • Careful correction of hyponatremia with 3% hypertonic saline if needed 1
  • Respiratory support if pulmonary edema develops 1

Common Pitfalls to Avoid

• Administering D5 or other hypotonic fluids in the immediate post-operative period, which can worsen hyponatremia 3
• Failing to monitor for signs of TURP syndrome, which may develop or worsen in the post-operative period 2
• Correcting hyponatremia too rapidly, which can lead to osmotic demyelination syndrome 6