The therapy consists of ending the surgery and reducing the fluid intake [7]. In symptomatic patients with low osmolarity (Na⁺ < 120 mEq/l), loop diuretics and hypertonic saline administration may be indicated. Abrupt correction of the electrolyte imbalance may result in central pontine myelinolysis. How much Na⁺ is needed can be estimated using Eq. 5.2. The substitution is done with a target increase in plasma Na⁺ of 1.5–2.0 mEq/l/h, until the Na + concentration is >125 mEq/l.

Calculation of the Na⁺ requirement in mEq (Eq. 5.2):

(ECF = extracellular fluid, ≈20 % of the body weight in kg)

The question’s phrasing already implies a No. As discussed in Sect. 5.1.9, TURP syndrome is the result of hypotonic hyperhydration. During the TURP, several bipolar prostate resection techniques can be used, and the use of an electrolyte-free irrigation fluid is not necessary. Absorption of isotonic saline solution rarely causes complications, even when large amounts enter the circulation.

An additional technique is laser resection of the prostate, which also uses isotonic saline solution. Laser resections are often time-consuming, but have the advantage that blood vessels during the resection are cauterized, thereby preventing inundation and bleeding. It is therefore the procedure of choice in large adenomas and patients with congestive heart failure who would not tolerate hypervolemia very well.

>> Dr. Damian was unsure about the therapy as attending anesthesiologist Dr. Eldridge gave the orders. “Ron, give Mr. Copper 20 mg furosemide IV and prepare a CPAP mask. Also, we need to change the norepinephrine infusion for dobutamine – his heart needs some help to clear the absorbed fluid. Why don’t you go ahead and do that, Dr. Damian. I will place a CVC.”

Mr. Copper didn’t show any reaction as the procedures were performed; he merely moaned as the CPAP mask was fastened around his head. Placement of the CVC occurred without incident. After exchanging the vasopressor infusions, Mr. Copper’s blood pressure dropped to 60/35 mmHg, and the heart rate was 50 beats/min. “Shouldn’t the blood pressure be higher?” asked Dr. Damian, turning to his attending. “It will be in a second,” replied Dr. Eldridge. “But you’re right, we need to do something to improve his cardiac output – what would you suggest?”

The arterial blood gas showed anemia with a hematocrit of 22 %. Every person has his own individual critical hemoglobin level. Circulatory depression in the presence of anemia and euvolemia is an indication for transfusion (Sect. 4.​1.​11).

>> Tech Ron prepared to transfuse two bags of packed RBCs, under the orders of attending anesthesiologist Dr. Eldridge. Meanwhile, the dobutamine infusion was running at 20 μg/kg/min; its only effect was that the pulse was now 110 beats/min. The blood pressure was 70/45 mmHg. “It will be better just as soon as he’s got the blood,” said Dr. Eldridge.

The bags were pressure transfused and brought the pressure up to 85/50 mmHg. However, shortly after the last bag was in, the blood pressure fell again. The heart rate increased to 120 beats/min.