Advertisement

Changes in amino acids, ammonium, and coagulation factors after transcervical resection of the endometrium with a glycine solution used for uterine irrigation

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      OBJECTIVE: Transcervical resection of the endometrium with the use of 1.5% glycine for irrigation is associated with postoperative nausea in some patients. This could be because of hyponatremia or toxic effects of glycine and its metabolites. Moreover, 1.5% glycine is hypoosmolar, and hemolysis and fibrinolysis are possible. Changes in plasma factors related to these potential complications of transcervical resection of the endometrium were measured.
      STUDY DESIGN: In 101 patients undergoing transcervical resection of the endometrium sodium, ammonium, and coagulation factors were measured preoperatively and postoperatively at intervals. In the initial 30 patients glycine and 28 other amino acids were measured at the same intervals. The results were correlated with the patients' clinical status and operative parameters.
      RESULTS: Glycine and nine other amino acids and ammonia showed increased postoperative plasma levels; these changes were correlated with the absorption of the irrigating glycine solution and the development of hyponatremia. Minor activation of fibrinolysis and hemolysis was also seen.
      CONCLUSION: Nausea after transcervical resection of the endometrium with 1.5% glycine for irrigation may be partly explained by toxic effects of glycine and its secondary metabolites in addition to the effects of water intoxication and hyponatremia. Minor, clinically insignificant changes in the coagulation system may also occur. Studies on alternatives to glycine for creation of near-isotonic irrigating solutions are encouraged.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Magos AM
        • Baumann R
        • Turnbull AC
        Transcervical resection of endometrium in women with menorrhagic.
        BMJ. 1989; 298: 1209-1212
        • Magos AM
        • Baumann R
        • Lockwood GM
        • Turnbull AC
        Experience with the first 250 endometrial resections for.
        Lancet. 1991; 337: 1074-1078
        • Istre O
        • Schiotz H
        • Vormdal J
        • Sadik L
        • Vangen O
        • Forman A
        Transcervical resection of endometrium and fibroids: initial complications.
        Acta Obstet Gynaecol Scand. 1991; 70: 363-366
        • Rankin L
        • Steinberg LH
        Transcervical resection of the endometrium: a review of 400 consecutive patients.
        Br J Obstet Gynaecol. 1992; 99: 911-914
        • Creevy CD
        The importance of hemolysis during the transurethral prostatic resection: a clinical investigation.
        J Urol. 1948; 59: 1217-1232
        • Nesbit RM
        • Glickman SI
        The use of glycine solutions as an irrigating medium during transurethral resection.
        J Urol. 1948; 59: 1212-1216
        • Harrison RH
        • Boren JS
        • Robison H
        Dilutional hyponatremia shock: another concept of the transurethral prostatic resection reaction.
        J Urol. 1956; 75: 95-110
        • Madsen PO
        • Madsen RE
        Clinical and experimental evaluation of different irrigating fluids for transurethral surgery.
        J Invest Urol. 1965; 3: 122-129
        • Baggish MS
        • Brill AI
        • Rosensweig B
        • et al.
        Fatal acute glycine and sorbitol toxicity during operative hysteroscopy.
        J Gynecol Surg. 1993; 9: 137-142
        • Hoyt HS
        • Goebel JL
        • Lee HI
        • Shoenbrod J
        Types of shock-like reaction during transurethral resection and relation to acute renal failure.
        J Urol. 1958; 79: 500-505
        • Henderson DJ
        • Middleton RG
        Coma from hyponatremia following transuretral resection of the prostate.
        Urology. 1980; 15: 267-271
        • Shepard RL
        • Kraus SE
        • Babayan RK
        • Siroky MB
        The role of ammonia toxicity in the post transurethral prostatectomy syndrome.
        Br J Urol. 1987; 60: 349-351
        • Perier C
        • Frey J
        • Auboyer C
        • et al.
        Accumulation of glycolic acid and clyoxylic acid in serum in cases of transient hyperglycinemia after transurethral surgery.
        Clin Chem. 1988; 34: 1471-1473
        • Sellevoll O
        • Breivik H
        • Tveter K
        Changes in oncotic pressure, osmolality and electrolytes following transurethral resection of the prostate using glycine as irrigation solution.
        Scand J Urol Nephrol. 1983; 17: 31-36
        • Istre O
        • Skajaa K
        • Schoensbye A
        • Forman A
        Changes in serum electrolytes after transcervical resection of endometrium and submucous fibroids with use of glycine 1.5% for uterine irrigation.
        Obstet Gynecol. 1992; 80: 218-222
        • Arieff AI
        • Ayus JC
        Endometrial ablation complication by fatal hyponatremic encephalopathy.
        JAMA. 1993; 270: 1230-1232
        • Nyhan WL
        Non-ketonic hyperglycinemia.
        in: Scriver CR Beadet AL Sly WS Valle D The metabolic basis of inherited disease. 6th ed. McGraw-Hill, New York1989: 743-753
        • Kirwan PH
        • Ludlow J
        • Makepeace P
        • Layward E
        Hyperammonaemia after transcervical resection of the endometrium.
        Br J Obstet Gynaecol. 1993; 100: 603-604
        • Hahn RG
        Serum amino acid pattern and toxicity symptoms following the absorption of irrigation containing glycine in transurethral prostatic surgery.
        Acta Anaesthesiol Scand. 1988; 32: 493-501
        • Iglesias JJ
        • Sporer A
        • Gellman AC
        • Seebode JJ
        New Iglesias resectoscope with continuous irrigation, simultaneous suction and low intravesical pressure.
        J Urol. 1975; 114: 929-933
        • Devine DV
        • Kinney TR
        • Thomas PF
        • Rosse WF
        • Greenberg CS
        Fragment of d-dimer levels: an objective marker of vaso-occlusive crises and other complications of sickle cell diseases.
        Blood. 1986; 68: 317-319
        • Huxtable RJ
        Taurine and the oxidative metabolism of cystine.
        in: Frieden E Biochemistry of sulfur. Plenum Press, New York1986: 121-197
        • Mudd SH
        • Levy HL
        • Skovby F
        • et al.
        Disorders of transsulfuration.
        in: Scriver CR Beaudet AL Sly WS Valle D The metabolic basis of inherited disease. 6th ed. McGraw-Hill, New York1989: 693-734
        • Handler P
        • Kammin H
        • Harris JS
        The metabolism of parenterally administered amino acids.
        J Biol Chem. 1949; 149: 283-301
        • McChensey EW
        • Goldberg L
        • Harris ES
        Reappraisal of the toxicology of ethylene glycol.
        in: The metabolism of label glycollic and glyoxylic acid in the rhesus monkey. 3rd ed. Food Cosmet Toxicol. 10. 1972: 655-670
        • Zucker JR
        • Bull AP
        Independent plasma levels of sodium and glycine during transurethral resection of the prostate.
        Can Anaesth Soc J. 1984; 31: 307-313
        • Doolan PD
        • Harper HA
        • Hutchin ME
        • Alpen EL
        The renal tubular response to amino acid loading.
        J Clin Invest. 1956; 35: 888-896
        • Olney JW
        • Ho O
        • Rhee V
        • Schrainker B
        Cysteine-induced brain damage in infants and fetal rodents.
        Brain Res. 1972; 45: 309-313