Turp today

[turnupthevapor]

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94 yo male

guy is sharp as a whip, preserved lv f(x) afib

planned turp time =30 minutes. At the 30 min mark surgeon keeps going to get hemostasis, did a venous gas at 35 minutes = Na 122, gave lasix and turned fluids off. ....keeps turping, and turping, and turping despite beint told to freakin stop already.

Na at end of case 115

pt is lucid, no MS change no sz

to RR I call for 3% to have handy but don't plan on giving any at this point

nephrology comes down, doesnt do much just want it to come up slow as they claim elderly are prone to CPD

everyone agree?

now 8 hours later sodium is 122 still doing well (renal starts 50 cc hr d5W cause they don't want it to come up that fast)

If i were to give 3%, probably would have give 100 cc's over a few hours i guess w Na measurement q 1hr until sx's go away (he had no symptoms though)


i will let you know how he does

 

[aphistis]

What was his baseline Na? How long did the surgeon spend TURPing?

 

[turnupthevapor]

140

1 hr

 

[dhb]

now 8 hours later sodium is 122 still doing well (renal starts 50 cc hr d5W cause they don't want it to come up that fast)

8h later his Na should have been > 135. The dude has water overload not hyponatremia per se, the longer he stays with a low Na the higher the probability of complications.

 

[jetproppilot]

(renal starts 50 cc hr d5W cause they don't want it to come up that fast)

😆😆

 

[aredoubleyou]

As a general rule, as I understand it, you can correct the sodium as quick as it dropped, so if it drops 15 points in a half hour, and you replace it back in a half hour no worries. Your chronically hyponatraemic patient is at risk for demylenation syndrome with rapid correction, not so much in the acute setting. That being said if he's not having symptoms, it cant hurt replacing the sodium slowly - just probably not neccessary.

 

[dhb]

Slow is fine but 115 to 122 in 8h is like doing nothing.

 

[dhb]

And don't forget to the bean doc