female TURP syndrome

[yogenbhatt1]

Had a case of Hystero-laparoscopic Myomectomy, a young girl of 16 yrs, who went in LVF, and all other signs of TURP syndrome. She was under GA. Her Sodium dropped to 109.
Can any one throw more light on sodium correction? How fast we can give 3 % NS?
Any other recommendation?
Does Soda Bi Carb Help in providing instant sodium?

[jafo1964]

If hyponatremia is suspected

TREATMENT RECOMMENDATION is
0.9% NaCl
Restrict Free water
Loop Diuretics
K correction
If symptomatic – 3% NaCl 100 ml B.D at 10 ml / hour

HYPERTONIC SALINE USAGE GUIDELINES
The required sodium is calculated as
Na Requirement = (Desired Na – Actual Na) X 0.6 X Body Weight

TARGETED CHANGES IN PLASMA Na should be around
Hourly   0.5 – 1 mmol / L / Hr
1st Day   < 10 - 12 mmol / L
2nd Day   ≤ 18 mmol / L
Do Not exceed over 24 hrs   ≤ 12 mmol / L

Severe Symptomatic Hyponatremia
< 115 mmol / L   correct at rate of 1 – 2 mmol / L / Hr  For 3- 4 hours

1 LITRE OF 3% NaCl WILL RAISE Na BY
(Infusate Na/L – Serum Na) / ( Total Body water + 1)
Total Body water = 0.6 X Body Weight
BTW 3% NaCl contains 513 mmol of sodium

ACUTE CORRECTION INTERRUPTION is recommended if
Symptoms Abolished
Safe plasma Na Level 125 mmol / L
Total Magnitude of Correction > 20 mmol / L

OSMOTIC DEMYELINATION SYNDROMEmust be monitores for. It presents with
Flaccid Paralysis
Dysarthria
Dysphasia

I guess NaHCO3 can be used it has almost 1500 mmol of sodium/ litre
But it unfortunately also produces
hyperosmolarity
CO2 production whosw elimination must be ensured
Paradoxical CNS acidosis which is difficult to treat

These are the prectice guidelines and we have had good results in the few patients we have handled

regs

[yogenbhatt1]

Back agian on the site as usual, Thanks for that, I knew you will reply.
I went through the net and a paper mentioned that you give 100 ml of 3 % NS stat over an hour, and 50 ml per hour after that till mEq is 125.
I could not digest it, as I have never given it that fast, hense I put it over to you.
Soda bi Carb was suggested by a physician, present on the site, where the event took place, and he suggested to use it, providing I take care of CO2.