Serum glucose as a predictor of fluid absorption during transurethral bipolar prostatic surgery

Thomas, Joseph Tim and Chawla, Arun and Thomas, Joseph (2010) Serum glucose as a predictor of fluid absorption during transurethral bipolar prostatic surgery. Indian Journal of Urology, 26 (3). pp. 466-468.

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Abstract

This study was conducted to evaluate if glucose added to the irrigant can be used as a tracer for fluid absorption during transurethral resection of prostate (TURP). The clinical part of the study investigated whether the changes in serum glucose concentration matched that of the serum sodium concentration. Monopolar TURP was performed in 250 patients with the patients randomized to receive either 1.5% glycine or 5% glucose as the irrigant. Blood samples were taken just before and 5 min after the procedure for the measurement of serum glucose and sodium concentrations. The second experimental part of the study was on 10 healthy volunteers aimed at creating a nomogram correlating the irrigating fluid volume and the increase in serum glucose. A constant infusion of acetated Ringer lactate at 20 mL/kg with 1% glucose was administered over 30 min. Blood samples were collected at different periods for various biochemical analyses, including glucose concentration. There was no change in serum sodium or serum glucose concentrations in patients who had 1.5% glycine as irrigant when there was no absorption. However, when there was fluid absorption, there was a significant correlation between the decrease in the serum sodium and increase in the serum glucose concentration when 5% glucose in water was used as the irrigating solution. The results also showed that the absorption of the irrigating fluid containing isotonic glucose increased the serum glucose concentration in inverse linear proportion to the reduction in serum sodium concentration. The linearity included serum sodium changes from 0 to 20 mmol/L corresponding to the absorption of up to 3.5 L. This finding was used in the experimental model for identifying the potential usefulness of glucose as a tracer in bipolar transurethral surgery. The tracer was evaluated based on kinetic data derived from volunteers who received the infusion of Ringer's acetate with 1% glucose. A nomogram was constructed, which showed that regardless of the pattern of absorption in a 1-h operation, the absorption of 1 and 2 L would increase the plasma glucose concentration by 3.7 and 6.9 mmol/L followed by a decrease of 30% per 10 min. It has been shown by clinical trials that serum glucose concentration will not change due to endocrine variations during TURP if there is no fluid absorption, even in diabetics. Taking this variation into consideration, the study has shown that the existence of absorption can be detected with 95% confidence if the plasma concentration increases by more than 1.4 mmol/L.

Item Type: Article
Subjects: Medicine > KMC Manipal > Anaesthesiology
Medicine > KMC Manipal > Urology
Depositing User: KMC Manipal
Date Deposited: 07 Feb 2013 04:56
Last Modified: 07 Feb 2013 04:56
URI: http://eprints.manipal.edu/id/eprint/78217

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