{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T07:08:34Z","timestamp":1769843314145,"version":"3.49.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Transurethral resection of the prostate (TUR-P) could incidentally cause hyponatremia, known as TUR syndrome due to intravascular absorption of non-electrolytic irrigation fluid. Recently, normal saline has been used as an irrigation fluid in a new system named TURis (TUR in saline) to prevent TUR syndrome. However, rapid massive absorption of normal saline can also cause other systemic adverse events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 71-year-old man underwent TURis for benign prostatic hyperplasia under spinal anesthesia. The patient lost consciousness which led upper airway obstruction and hypoxia 30 min after the surgery began. Blood gas test indicated hyperchloremic metabolic acidosis. While vasoactive agents were ineffective, the administration of bicarbonate significantly improved the symptoms and restored blood pressure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>We experienced a case of hyperchloremic metabolic acidosis with decreased level of consciousness and hypotension during TURis. Administration of bicarbonate, but not phenylephrine, was effective for recovering blood pressure.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40981-022-00532-5","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T02:05:37Z","timestamp":1655777137000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Symptomatic absorption of normal saline during transurethral resection of the prostate: a case report"],"prefix":"10.1186","volume":"8","author":[{"given":"Naomi","family":"Okuma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Hino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madoka","family":"Kuroki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadashi","family":"Matsuura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Mori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"532_CR1","doi-asserted-by":"publisher","first-page":"2665","DOI":"10.1016\/S0022-5347(05)64240-1","volume":"168","author":"H Shiozawa","year":"2002","unstructured":"Shiozawa H, Aizawa T, Ito T, Miki M. A new transurethral resection system: operating in saline environment precludes obturator nerve reflexes. J Urol. 2002;168:2665\u20137.","journal-title":"J Urol"},{"key":"532_CR2","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.eururo.2010.06.005","volume":"58","author":"SA Ahyai","year":"2010","unstructured":"Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384\u201397.","journal-title":"Eur Urol"},{"key":"532_CR3","doi-asserted-by":"publisher","first-page":"e13807","DOI":"10.1111\/and.13807","volume":"53","author":"D Castellani","year":"2021","unstructured":"Castellani D, Gasparri L, Faloia L, Veccia D, Giampieri M, Dellabella M. Fluid overload syndrome: a potentially life-threatening complication of thulium laser enucleation of the prostate. Andrologia. 2021;53:e13807.","journal-title":"Andrologia"},{"key":"532_CR4","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1097\/00000542-199905000-00007","volume":"90","author":"S Scheingraber","year":"1999","unstructured":"Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology. 1999;90:1265\u201370.","journal-title":"Anesthesiology"},{"key":"532_CR5","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/aas.12834","volume":"61","author":"J Johansson","year":"2017","unstructured":"Johansson J, Lindahl M, Gyllencreutz E, Hahn RG. Symptomatic absorption of isotonic saline during transcervical endometrial resection. Acta Anaesthesiol Scand. 2017;61:121\u20134.","journal-title":"Acta Anaesthesiol Scand"},{"key":"532_CR6","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1038\/nrneph.2010.33","volume":"6","author":"JA Kraut","year":"2010","unstructured":"Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6:274\u201385.","journal-title":"Nat Rev Nephrol"},{"key":"532_CR7","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1097\/00000542-196011000-00009","volume":"21","author":"HL Price","year":"1960","unstructured":"Price HL. Effects of carbon dioxide on the cardiovascular system. Anesthesiology. 1960;21:652\u201363.","journal-title":"Anesthesiology"},{"key":"532_CR8","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.juro.2014.07.117","volume":"193","author":"T Hermanns","year":"2015","unstructured":"Hermanns T, Grossmann NC, Wettstein MS, Fankhauser CD, Capol JC, Poyet C, et al. Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol. 2015;193:211\u20136.","journal-title":"J Urol"},{"key":"532_CR9","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/S0022-5347(05)00239-9","volume":"175","author":"HN Shah","year":"2006","unstructured":"Shah HN, Kausik V, Hegde S, Shah JN, Bansal MB. Evaluation of fluid absorption during holmium laser enucleation of prostate by breath ethanol technique. J Urol. 2006;175:537\u201340.","journal-title":"J Urol"},{"key":"532_CR10","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1007\/s00540-016-2256-4","volume":"30","author":"SE Dodd","year":"2016","unstructured":"Dodd SE, Jankowski CJ, Krambeck AE, Gali B. Metabolic acidosis with hemodilution due to massive absorption of normal saline as bladder irrigation fluid following holmium laser enucleation of prostate. J Anesth. 2016;30:1060\u20132.","journal-title":"J Anesth"},{"issue":"271","key":"532_CR11","first-page":"e1","volume":"207","author":"BA Dyrbye","year":"2012","unstructured":"Dyrbye BA, Overdijk LE, van Kesteren PJ, de Haan P, Riezebos RK, Bakkum EA, et al. Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial. Am J Obstet Gynecol. 2012;207(271):e1\u20136.","journal-title":"Am J Obstet Gynecol"}],"container-title":["JA Clinical Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-022-00532-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40981-022-00532-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-022-00532-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T02:08:54Z","timestamp":1655777334000},"score":1,"resource":{"primary":{"URL":"https:\/\/jaclinicalreports.springeropen.com\/articles\/10.1186\/s40981-022-00532-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["532"],"URL":"https:\/\/doi.org\/10.1186\/s40981-022-00532-5","relation":{},"ISSN":["2363-9024"],"issn-type":[{"value":"2363-9024","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,21]]},"assertion":[{"value":"29 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 June 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written consent for publication of this paper has been obtained from the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"43"}}